Healthcare Provider Details

I. General information

NPI: 1740602937
Provider Name (Legal Business Name): JESSICA SAWYER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2014
Last Update Date: 01/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3028 OLD MARION RD
METROPOLIS IL
62960-2942
US

IV. Provider business mailing address

3028 OLD MARION RD
METROPOLIS IL
62960-2942
US

V. Phone/Fax

Practice location:
  • Phone: 618-524-2645
  • Fax:
Mailing address:
  • Phone: 618-524-2645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number150011289
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: