MEDICARE: JON CRAIG REARDON 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-11121	AZ

General Provider Information

NPI Number	:	1437306362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JON CRAIG REARDON LCSW

Provider Business Mailing Address
First Line	:	5055 E BROADWAY BLVD STE C-104
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-3641
Country	:	US
Telephone Number	:	520-571-6461
Fax Number	:	520-512-4056

Provider Business Practice Location Address
First Line	:	5055 E BROADWAY BLVD STE C-104
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-3641
Country	:	US
Telephone Number	:	520-571-6461
Fax Number	:	520-512-4056

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

Provider Enumeration Date	:	08/21/2008
Last Update Date	:	06/17/2013

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