MEDICARE: DR. JENNA TESO 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	104100000X	Social Worker	LCSW-17506	AZ

General Provider Information

NPI Number	:	1659849842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNA TESO LCSW

Provider Business Mailing Address
First Line	:	8500 E OLD SPANISH TRL APT 17
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85710-4371
Country	:	US
Telephone Number	:	520-528-6534
Fax Number	:

Provider Business Practice Location Address
First Line	:	4560 E BROADWAY BLVD STE 223
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-3558
Country	:	US
Telephone Number	:	520-528-6534
Fax Number	:

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

Provider Enumeration Date	:	11/06/2018
Last Update Date	:	11/06/2018

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