Healthcare Provider Details

I. General information

NPI: 1346642279
Provider Name (Legal Business Name): KRISTIN JASKI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 ABERCORN ST, SUITE 301B
SAVANNAH GA
31401
US

IV. Provider business mailing address

127 ABERCORN ST STE 301B
SAVANNAH GA
31401-4069
US

V. Phone/Fax

Practice location:
  • Phone: 917-405-9640
  • Fax:
Mailing address:
  • Phone: 917-405-9640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number05482500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW0064778
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: