Individual
DANA DAYLE JESSUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSCSW
Contact information
Practice address
17821 78TH ST, MC LOUTH, KS 66054-5091
(785) 742-7113
(785) 742-3085
Mailing address
17821 78TH ST, MC LOUTH, KS 66054-5091
(785) 742-7113
(785) 742-3085
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
KS
1041C0700X
Clinical Social Worker
Primary
3142
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100097950A
—
KS
05
—
100097950B
—
KS
Enumeration date
07/10/2006
Last updated
02/14/2017
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