Provider Demographics
NPI:1922574300
Name:POTTORFF, JESSICA A (MS, MA, CADC, LMHC)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:A
Last Name:POTTORFF
Suffix:
Gender:F
Credentials:MS, MA, CADC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8450 HICKMAN RD STE 10
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-4307
Mailing Address - Country:US
Mailing Address - Phone:515-643-6563
Mailing Address - Fax:515-643-6598
Practice Address - Street 1:8450 HICKMAN RD STE 10
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-4307
Practice Address - Country:US
Practice Address - Phone:713-837-6294
Practice Address - Fax:515-608-4612
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-23
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
IA115248101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)