Healthcare Provider Details

I. General information

NPI: 1003636150
Provider Name (Legal Business Name): JESSICA A ALDRICH LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA A DIPPER

II. Dates (important events)

Enumeration Date: 10/14/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1423 N JEFFERSON AVE FL 3
SPRINGFIELD MO
65802-1917
US

IV. Provider business mailing address

PO BOX 844715
KANSAS CITY MO
64184-4715
US

V. Phone/Fax

Practice location:
  • Phone: 417-761-5000
  • Fax:
Mailing address:
  • Phone: 417-761-5214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2024036961
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: