Provider Demographics
NPI:1023740784
Name:KIRK, JESSICA (M ED)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:KIRK
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 SECOND AVE REAR
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2609
Mailing Address - Country:US
Mailing Address - Phone:610-707-9206
Mailing Address - Fax:
Practice Address - Street 1:134 SECOND AVE
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-2609
Practice Address - Country:US
Practice Address - Phone:610-707-9206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor