MEDICARE: MS. M JENISE COMER MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	1219	MO

General Provider Information

NPI Number	:	1043420953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. M JENISE COMER MSW

Provider Business Mailing Address
First Line	:	7416 RICHMOND AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64133-6261
Country	:	US
Telephone Number	:	816-213-9490
Fax Number	:	660-543-8215

Provider Business Practice Location Address
First Line	:	7416 RICHMOND AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64133-6261
Country	:	US
Telephone Number	:	816-213-9490
Fax Number	:	660-543-8215

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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