Provider Demographics
NPI:1255792990
Name:BUCZEK, JESSICA RAE (MS, LPCC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:RAE
Last Name:BUCZEK
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W RAHN RD STE 26
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2291
Mailing Address - Country:US
Mailing Address - Phone:937-479-2793
Mailing Address - Fax:
Practice Address - Street 1:30 W RAHN RD STE 26
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2291
Practice Address - Country:US
Practice Address - Phone:937-479-2793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0900463101YP2500X
OHE.1800567101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional