MEDICARE: JACKSON GRIFFIN ASW

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	109349	CA

General Provider Information

NPI Number	:	1508587072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKSON GRIFFIN ASW

Provider Business Mailing Address
First Line	:	669 PALMETTO AVE STE A
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95926-4065
Country	:	US
Telephone Number	:	530-364-5663
Fax Number	:

Provider Business Practice Location Address
First Line	:	669 PALMETTO AVE STE A
Second Line	:
City	:	CHICO
State	:	CA
Zip	:	95926-4065
Country	:	US
Telephone Number	:	530-566-3480
Fax Number	:

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

Provider Enumeration Date	:	09/02/2022
Last Update Date	:	09/02/2022

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Directions to “ JACKSON GRIFFIN ASW” Practice Location

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