Healthcare Provider Details

I. General information

NPI: 1699250266
Provider Name (Legal Business Name): JESSICA LYNNE SCHWARZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2018
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20180 HIGHWAY 32
LICKING MO
65542
US

IV. Provider business mailing address

1000 HOSPITAL RD
WAYNESVILLE MO
65583-2634
US

V. Phone/Fax

Practice location:
  • Phone: 910-551-5423
  • Fax:
Mailing address:
  • Phone: 573-774-5353
  • Fax: 573-774-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2017039880
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2017039880
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: