Individual
JESSICA L SOUKUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
407 N WALSH ST, CARSON CITY, NV 89701-4268
(775) 720-8676
(775) 418-7636
Mailing address
1064 RIDGEFIELD DR, CARSON CITY, NV 89706-4372
(775) 720-8676
(775) 418-7636
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4690-C
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4960-C
STATE LICENSE
NV
Enumeration date
08/13/2009
Last updated
12/02/2022
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