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NPI Code Detail

MEDICARE: MS. JERRI CARLSON

MEDICARE: MS. JERRI CARLSON
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 Worker34005802AIN

General Provider Information

NPI Number : 1730311994
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JERRI CARLSON
Provider Business Mailing Address
First Line : 3734 ASHLEY OAKS DR
Second Line : APARTMENT A
City : LAFAYETTE
State : IN
Zip : 47905-6012
Country : US
Telephone Number : 765-418-8310
Fax Number :
Provider Business Practice Location Address
First Line : 3734 ASHLEY OAKS DR
Second Line : APARTMENT A
City : LAFAYETTE
State : IN
Zip : 47905-6012
Country : US
Telephone Number : 765-418-8310
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2009
Last Update Date : 08/20/2009

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Directions to “ MS. JERRI CARLSON ” Practice Location

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