Healthcare Provider Details

I. General information

NPI: 1447168968
Provider Name (Legal Business Name): JESSICA LOUISE RICKEY CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA LOUISE JONES

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SE CROSS ST
MOUNT STERLING IL
62353-1561
US

IV. Provider business mailing address

700 SE CROSS ST
MOUNT STERLING IL
62353-1561
US

V. Phone/Fax

Practice location:
  • Phone: 217-773-3325
  • Fax:
Mailing address:
  • Phone: 217-773-3325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCADC-45408
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: