MEDICARE: MS. JENNIFER LYNN WHITE LMSW

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	AZ-14022	AZ

General Provider Information

NPI Number	:	1982410924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER LYNN WHITE LMSW

Provider Business Mailing Address
First Line	:	17063 S PAINTED VISTAS WAY
Second Line	:
City	:	VAIL
State	:	AZ
Zip	:	85641-2435
Country	:	US
Telephone Number	:	520-468-1327
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 E PENNSYLVANIA ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85714-3310
Country	:	US
Telephone Number	:	520-806-0071
Fax Number	:

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

Provider Enumeration Date	:	12/04/2024
Last Update Date	:	12/04/2024

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