MEDICARE: JESSICA HERNANDEZ

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	6801116024	MI

General Provider Information

NPI Number	:	1124716618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA HERNANDEZ

Provider Business Mailing Address
First Line	:	390 COACHMAN DR APT 1A
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48083-4748
Country	:	US
Telephone Number	:	530-781-3221
Fax Number	:

Provider Business Practice Location Address
First Line	:	390 COACHMAN DR APT 1A
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48083-4748
Country	:	US
Telephone Number	:	530-781-3221
Fax Number	:

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

Provider Enumeration Date	:	04/24/2023
Last Update Date	:	04/24/2023

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Directions to “ JESSICA HERNANDEZ ” Practice Location

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