MEDICARE: JESSICA DOUGLAS LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	10097	TN

General Provider Information

NPI Number	:	1780545129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA DOUGLAS LCSW

Provider Business Mailing Address
First Line	:	202 AULTMAN RD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37920-3557
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 AULTMAN RD
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37920-3557
Country	:	US
Telephone Number	:	423-494-7853
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/24/2025
Last Update Date	:	02/18/2026

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