MEDICARE: JESSICA STORCK LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	178021497	IL

General Provider Information

NPI Number	:	1578358610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA STORCK LPC

Provider Business Mailing Address
First Line	:	111 W WASHINGTON ST STE 410B
Second Line	:
City	:	EAST PEORIA
State	:	IL
Zip	:	61611-2532
Country	:	US
Telephone Number	:	309-689-2990
Fax Number	:	309-689-2991

Provider Business Practice Location Address
First Line	:	111 W WASHINGTON ST STE 410B
Second Line	:
City	:	EAST PEORIA
State	:	IL
Zip	:	61611-2532
Country	:	US
Telephone Number	:	309-689-2990
Fax Number	:	309-689-2991

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2025
Last Update Date	:	04/10/2025

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