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General NPI Number Information
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NPI Number | 1922063965
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Entity Type | Individual
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Provider Name | JEFFREY ROBERT DARNELL LCSW
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Gender | Male
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 04/28/2010
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Provider Practice Location Address
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Address Line | 500 E VETERANS ST 425/7
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City | TOMAH
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State | WI
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Zip | 54660-3105
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Country | US
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Telephone | 800-872-8662
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Fax | 608-372-1779
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Provider Business Mailing Address
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Address Line | 24691 EMBAY AVE APT B
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City | TOMAH
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State | WI
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Zip | 54660-4345
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Country | US
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Telephone | 800-872-8662
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Fax | 608-372-1779
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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 | 989488
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License Number State | CO
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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 | 989488
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License Number State | CO
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