Healthcare Provider Details

I. General information

NPI: 1891203535
Provider Name (Legal Business Name): JESSICA ELIZABETH BIFFAR LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA HUBBS LCPC

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 S METTER AVE
COLUMBIA IL
62236-2253
US

IV. Provider business mailing address

420 S LIBRARY ST
WATERLOO IL
62298-1433
US

V. Phone/Fax

Practice location:
  • Phone: 618-281-9282
  • Fax:
Mailing address:
  • Phone: 636-667-1576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180.011560
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180011560
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: