MEDICARE: JENNA LEEANN WOLBERT LSW

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	104100000X	Social Worker	SW140330	PA

General Provider Information

NPI Number	:	1164294237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA LEEANN WOLBERT LSW

Provider Business Mailing Address
First Line	:	1134 LIBERTY ST
Second Line	:
City	:	FRANKLIN
State	:	PA
Zip	:	16323-1223
Country	:	US
Telephone Number	:	814-346-1312
Fax Number	:	814-346-1312

Provider Business Practice Location Address
First Line	:	1134 LIBERTY ST
Second Line	:
City	:	FRANKLIN
State	:	PA
Zip	:	16323-1223
Country	:	US
Telephone Number	:	814-346-1312
Fax Number	:	814-346-1312

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

Provider Enumeration Date	:	10/23/2023
Last Update Date	:	10/23/2023

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