Healthcare Provider Details

I. General information

NPI: 1033505136
Provider Name (Legal Business Name): JESSICA LEANN MARTIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA LEANN MARTIN

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 MCQUAY AVE
POCAHONTAS AR
72455-2407
US

IV. Provider business mailing address

PO BOX 83
CORNING AR
72422-0083
US

V. Phone/Fax

Practice location:
  • Phone: 870-892-9949
  • Fax: 870-892-0208
Mailing address:
  • Phone: 870-857-3334
  • Fax: 870-857-9934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9579-C
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: