MEDICARE: JEANNE L TOMASIEWICZ MA, LPC

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	101YP2500X	Professional Counselor	LPC-11594	AZ

General Provider Information

NPI Number	:	1588946164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNE L TOMASIEWICZ MA, LPC

Provider Business Mailing Address
First Line	:	2301 W DUNLAP AVE STE 206
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-2846
Country	:	US
Telephone Number	:	602-750-8705
Fax Number	:	602-674-5601

Provider Business Practice Location Address
First Line	:	2301 W DUNLAP AVE STE 206
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-2846
Country	:	US
Telephone Number	:	602-750-8705
Fax Number	:	602-674-5601

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

Provider Enumeration Date	:	09/09/2011
Last Update Date	:	09/09/2011

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