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NPI Code Detail

MEDICARE: MS. JENNIFER ANN FITKIN LCSW

MEDICARE: MS. JENNIFER ANN FITKIN LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker06796IA
21041C0700XClinical Social Worker6101-CNV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023261401
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JENNIFER ANN FITKIN LCSW
Provider Business Mailing Address
First Line : 3680 N RANCHO DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89130-3180
Country : US
Telephone Number : 319-415-9697
Fax Number :
Provider Business Practice Location Address
First Line : 3680 N RANCHO DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89130-3180
Country : US
Telephone Number : 319-415-9697
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2008
Last Update Date : 10/30/2015

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