MEDICARE: MS. JESSICA LYNN WOLFINGER 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	SW11783	FL

General Provider Information

NPI Number	:	1134189277
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA LYNN WOLFINGER LCSW

Provider Business Mailing Address
First Line	:	5539 SASSPARILLA LN
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32821-7940
Country	:	US
Telephone Number	:	407-666-9966
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 PARK PLACE BLVD
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-2344
Country	:	US
Telephone Number	:	407-666-9966
Fax Number	:

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	02/04/2015

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