Healthcare Provider Details

I. General information

NPI: 1780959494
Provider Name (Legal Business Name): JESSICA RENA BARNES LICSW, LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA RENA GRIMSLEY LICSW, LISW

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 04/12/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 ARBOR DRIVE
SOUTH SIOUX CITY NE
68776-6877
US

IV. Provider business mailing address

PO BOX 355
SOUTH SIOUX CITY NE
68776-0355
US

V. Phone/Fax

Practice location:
  • Phone: 712-490-4398
  • Fax:
Mailing address:
  • Phone: 712-490-4398
  • Fax: 402-494-3356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1453
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number007194
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1011
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: