Individual
JESIKA M GOMEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSM, LCSW
Contact information
Practice address
804 S NATALIE AVE, SPRINGFIELD, MO 65802-9702
(417) 207-9039
Mailing address
804 S NATALIE AVE, SPRINGFIELD, MO 65802-9702
(417) 207-9039
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
2019014457
MO
1041C0700X
Clinical Social Worker
Primary
2021034285
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14467421
CAQH
—
05
—
490074371
—
MO
Enumeration date
06/13/2019
Last updated
01/05/2024
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