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NPI Code Detail

MEDICARE: JANE HURLEY-JOHNCOX LICSW

MEDICARE: JANE HURLEY-JOHNCOX LICSW
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 Worker03303MN

General Provider Information

NPI Number : 1710019567
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANE HURLEY-JOHNCOX LICSW
Provider Business Mailing Address
First Line : 1311 DEVONSHIRE CURV
Second Line :
City : BLOOMINGTON
State : MN
Zip : 55431-5001
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2649 PARK AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1006
Country : US
Telephone Number : 612-676-1604
Fax Number : 612-379-8235
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2007
Last Update Date : 10/30/2007

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