MEDICARE: MS. JENNIFER DORY PAHL 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	4871-C	NV

General Provider Information

NPI Number	:	1679613285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER DORY PAHL LCSW

Provider Business Mailing Address
First Line	:	PO BOX 2497
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89702-2497
Country	:	US
Telephone Number	:	775-884-0707
Fax Number	:	775-884-2569

Provider Business Practice Location Address
First Line	:	309 E JOHN ST STE 1
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89706-3071
Country	:	US
Telephone Number	:	775-884-0707
Fax Number	:	775-884-2569

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	07/08/2007

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