Individual
JESSE KOSKOVICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.P.C.
Contact information
Practice address
2113 S 54TH ST STE 5, ROGERS, AR 72758-8169
(402) 210-8224
Mailing address
980 REDFREE DR, BENTONVILLE, AR 72712-3099
(402) 210-8224
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
A2107016
—
101YP2500X
Professional Counselor
Primary
P2411020
AR
106S00000X
Behavior Technician
19-77966
AR
Other
Enumeration date
02/12/2020
Last updated
11/22/2024
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