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General NPI Number Information
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NPI Number | 1841653912
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Entity Type | Individual
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Provider Name | JESSICA MAYNARD
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Gender | Female
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Dates
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Enumeration Date | 04/05/2016
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 1380 N PALAFOX ST
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City | PENSACOLA
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State | FL
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Zip | 32501-2641
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Country | US
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Telephone | 850-512-1430
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Fax | 850-999-0261
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Provider Business Mailing Address
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Address Line | 2315 W JACKSON ST
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City | PENSACOLA
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State | FL
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Zip | 32505-7552
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Country | US
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Telephone | 850-436-4363
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Fax | 850-436-2095
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | ISW21960
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License Number State | FL
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