Provider Demographics
NPI:1164211595
Name:PEARSON, JESSICA (LSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:PEARSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-0246
Mailing Address - Country:US
Mailing Address - Phone:208-234-2244
Mailing Address - Fax:
Practice Address - Street 1:620 W FREMONT ST
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-3053
Practice Address - Country:US
Practice Address - Phone:208-234-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLSW-38679104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker