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NPI Code Detail

MEDICARE: MRS. JESSICA A. ISELIN LISW

MEDICARE: MRS. JESSICA A. ISELIN LISW
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
11041C0700XClinical Social WorkerI 0900297OH

General Provider Information

NPI Number : 1083914394
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JESSICA A. ISELIN LISW
Provider Business Mailing Address
First Line : 825 GRANDVIEW AVE
Second Line :
City : COLUMBUS
State : OH
Zip : 43215-1123
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 825 GRANDVIEW AVE
Second Line :
City : COLUMBUS
State : OH
Zip : 43215-1123
Country : US
Telephone Number : 614-258-9927
Fax Number : 614-487-9415
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2010
Last Update Date : 11/02/2010

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