Healthcare Provider Details

I. General information

NPI: 1548734155
Provider Name (Legal Business Name): JOLYN ANDREWS LCSW 21345
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 S SANDSTONE ST
GILBERT AZ
85296-1306
US

IV. Provider business mailing address

70 S SANDSTONE ST # NA
GILBERT AZ
85296-1306
US

V. Phone/Fax

Practice location:
  • Phone: 480-436-0813
  • Fax:
Mailing address:
  • Phone: 480-436-0813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number17361
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21345
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: