MEDICARE: JESSICA MARTIN LISW-S

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	S0700385	OH
2	1041C0700X	Clinical Social Worker	I.0900208-SUPV	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942451703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MARTIN LISW-S

Provider Business Mailing Address
First Line	:	899 E BROAD ST FL 3
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43205-1156
Country	:	US
Telephone Number	:	614-355-8000
Fax Number	:	614-355-8018

Provider Business Practice Location Address
First Line	:	390 N SPRING RD
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43082-1888
Country	:	US
Telephone Number	:	614-797-6633
Fax Number	:	614-797-6601

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

Provider Enumeration Date	:	10/09/2008
Last Update Date	:	08/12/2019

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