MEDICARE: JESSICA SUE JAYCOX

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	LCSW-1466	WY
2	1041C0700X	Clinical Social Worker	6801121272	MI

General Provider Information

NPI Number	:	1750941464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA SUE JAYCOX

Provider Business Mailing Address
First Line	:	3109 RIDGECREST DR
Second Line	:
City	:	GILLETTE
State	:	WY
Zip	:	82718-6009
Country	:	US
Telephone Number	:	307-760-6219
Fax Number	:

Provider Business Practice Location Address
First Line	:	3109 RIDGECREST DR
Second Line	:
City	:	GILLETTE
State	:	WY
Zip	:	82718-6009
Country	:	US
Telephone Number	:	307-760-6219
Fax Number	:

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

Provider Enumeration Date	:	06/14/2019
Last Update Date	:	04/19/2026

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