Basic Information
| Provider Information | |||||||||
| NPI: | 1285931543 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PLEVKA | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | JONNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 94 MAPLE ST | ||||||||
| Address2: | FIRST FLOOR | ||||||||
| City: | GARDNER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 014402221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9788951962 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 ERDMAN WAY | ||||||||
| Address2: | |||||||||
| City: | LEOMINSTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 014531804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784668384 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2011 | ||||||||
| LastUpdateDate: | 02/23/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.