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NPI Code Detail

MEDICARE: JAZMIN MENDOZA MSW, LCSW

MEDICARE: JAZMIN MENDOZA MSW, 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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1134849243
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAZMIN MENDOZA MSW, LCSW
Provider Business Mailing Address
First Line : 528 KANSAS CITY ST STE 3
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-5037
Country : US
Telephone Number : 605-299-9100
Fax Number : 605-250-5159
Provider Business Practice Location Address
First Line : 909 SAINT JOSEPH ST STE 201
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-3304
Country : US
Telephone Number : 605-431-4151
Fax Number : 605-431-4151
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2022
Last Update Date : 05/31/2024

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