MEDICARE: KAYLA JASPER

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
1	1041C0700X	Clinical Social Worker	CW024916	PA

General Provider Information

NPI Number	:	1124973367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA JASPER

Provider Business Mailing Address
First Line	:	134 W OXFORD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-3916
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	134 W OXFORD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19122-3916
Country	:	US
Telephone Number	:	609-903-2777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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