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NPI Code Detail

MEDICARE: JESSICA RAE LAXTON MSW

MEDICARE: JESSICA RAE LAXTON 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
11041C0700XClinical Social WorkerBP00947179WV

General Provider Information

NPI Number : 1104753243
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA RAE LAXTON MSW
Provider Business Mailing Address
First Line : 131 WELLNESS DR
Second Line :
City : SUMMERSVILLE
State : WV
Zip : 26651-5402
Country : US
Telephone Number : 888-736-3229
Fax Number : 304-872-5415
Provider Business Practice Location Address
First Line : 131 WELLNESS DR
Second Line :
City : SUMMERSVILLE
State : WV
Zip : 26651-5402
Country : US
Telephone Number : 888-736-3229
Fax Number : 304-872-5415
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2026
Last Update Date : 05/05/2026

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