MEDICARE: MRS. JENNA ASHLEY GRANT LCSW

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	8723-C	NV
2	104100000X	Social Worker
3	1041C0700X	Clinical Social Worker	8723-C
4	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1124474390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNA ASHLEY GRANT LCSW

Provider Business Mailing Address
First Line	:	500 E WARM SPRINGS RD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-4345
Country	:	US
Telephone Number	:	702-371-5508
Fax Number	:	702-486-6741

Provider Business Practice Location Address
First Line	:	6171 W CHARLESTON BLVD BLDG 17
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1126
Country	:	US
Telephone Number	:	702-486-8999
Fax Number	:	702-486-7759

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

Provider Enumeration Date	:	05/06/2016
Last Update Date	:	12/12/2025

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