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General NPI Number Information
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NPI Number | 1043686728
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Entity Type | Individual
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Provider Name | REBECCA RAE JESKE PLPC
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Gender | Female
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Dates
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Enumeration Date | 08/17/2015
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Last Update Date | 06/23/2016
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Provider Practice Location Address
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Address Line | 109 S 10TH ST
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City | LEXINGTON
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State | MO
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Zip | 64067-1364
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Country | US
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Telephone | 660-259-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 109 S 10TH ST
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City | LEXINGTON
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State | MO
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Zip | 64067-1364
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Country | US
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Telephone | 660-259-3900
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2015028817
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License Number State | MO
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