Healthcare Provider Details
I. General information
NPI: 1609796846
Provider Name (Legal Business Name): JESSICA PETERS MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
639 YORK ST RM 212
QUINCY IL
62301-3919
US
IV. Provider business mailing address
902 W MAIN ST
WEST FRANKFORT IL
62896-2210
US
V. Phone/Fax
- Phone: 217-222-6277
- Fax: 217-224-1155
- Phone: 618-326-2772
- Fax: 618-937-1440
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 104100000X |
| Taxonomy | Social Worker |
| License Number | 150.114340 |
| License Number State | IL |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: