Healthcare Provider Details

I. General information

NPI: 1023178001
Provider Name (Legal Business Name): JODI LAUREN WESLOW L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 N SAINT ASAPH ST
ALEXANDRIA VA
22314-1912
US

IV. Provider business mailing address

326 N OAKLAND ST
ARLINGTON VA
22203-3515
US

V. Phone/Fax

Practice location:
  • Phone: 703-838-6400
  • Fax: 703-838-5062
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904005978
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: