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General NPI Number Information
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NPI Number | 1679192298
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Entity Type | Individual
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Provider Name | SUSAN JAMIESON LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/14/2020
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Last Update Date | 06/08/2025
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Provider Practice Location Address
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Address Line | 1400 NE MCCLAIN RD STE 2
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City | BENTONVILLE
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State | AR
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Zip | 72712-3888
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Country | US
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Telephone | 479-657-6636
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Fax |
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Provider Business Mailing Address
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Address Line | 401 SW A ST APT 308
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City | BENTONVILLE
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State | AR
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Zip | 72712-5911
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Country | US
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Telephone | 954-937-6473
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 11496-C
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | FL
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