Healthcare Provider Details

I. General information

NPI: 1689971301
Provider Name (Legal Business Name): JESSICA GLENN LCSW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2011
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E GAY ST UNIT 704
WEST CHESTER PA
19381-5039
US

IV. Provider business mailing address

101 E GAY ST UNIT 704
WEST CHESTER PA
19381-5039
US

V. Phone/Fax

Practice location:
  • Phone: 214-885-4270
  • Fax:
Mailing address:
  • Phone: 214-885-4270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number079224
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number61422
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW026110
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: