Healthcare Provider Details

I. General information

NPI: 1184360414
Provider Name (Legal Business Name): JAZMINE WALKER LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 STREET RD
BENSALEM PA
19020-3755
US

IV. Provider business mailing address

PO BOX 748465
ATLANTA GA
30374-8465
US

V. Phone/Fax

Practice location:
  • Phone: 215-782-6844
  • Fax:
Mailing address:
  • Phone: 855-284-7483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW139690
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: