Healthcare Provider Details

I. General information

NPI: 1629905559
Provider Name (Legal Business Name): JESSICA LYNN LONDON LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 3RD AVE
WARREN PA
16365-2332
US

IV. Provider business mailing address

327 PENNSYLVANIA AVE # A
KANE PA
16735-1625
US

V. Phone/Fax

Practice location:
  • Phone: 814-230-3042
  • Fax:
Mailing address:
  • Phone: 814-952-6521
  • Fax: 814-952-6521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: