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NPI Code Detail

MEDICARE: JESSICA R POLK LCSW

MEDICARE: JESSICA R POLK 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 WorkerLCSW 74433CA

General Provider Information

NPI Number : 1477715340
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA R POLK LCSW
Provider Business Mailing Address
First Line : 2610 INDUSTRY WAY
Second Line :
City : LYNWOOD
State : CA
Zip : 90262-4283
Country : US
Telephone Number : 310-631-8004
Fax Number : 310-637-0473
Provider Business Practice Location Address
First Line : 2010 E EL SEGUNDO BLVD
Second Line :
City : COMPTON
State : CA
Zip : 90222-7109
Country : US
Telephone Number : 310-637-0917
Fax Number : 310-637-0473
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2008
Last Update Date : 11/14/2016

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Directions to “ JESSICA R POLK LCSW” Practice Location

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