Provider Demographics
NPI:1043686728
Name:JESKE, REBECCA RAE (PLPC)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:RAE
Last Name:JESKE
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:64067-1364
Mailing Address - Country:US
Mailing Address - Phone:660-259-3900
Mailing Address - Fax:
Practice Address - Street 1:109 S 10TH ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MO
Practice Address - Zip Code:64067-1364
Practice Address - Country:US
Practice Address - Phone:660-259-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015028817101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional