MEDICARE: JENNIFER M BRADOF 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
1	1041C0700X	Clinical Social Worker	LCSW-837	WY

General Provider Information

NPI Number	:	1275971442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER M BRADOF LCSW

Provider Business Mailing Address
First Line	:	PO BOX 2299
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-2299
Country	:	US
Telephone Number	:	307-222-6040
Fax Number	:

Provider Business Practice Location Address
First Line	:	480 S CACHE ST
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-8222
Country	:	US
Telephone Number	:	307-222-6040
Fax Number	:

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

Provider Enumeration Date	:	06/11/2013
Last Update Date	:	06/11/2013

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