MEDICARE: JENNIFER ANNE CHESTER 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	36084	TX

General Provider Information

NPI Number	:	1164598298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ANNE CHESTER LCSW

Provider Business Mailing Address
First Line	:	PO BOX 471081
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76147-1081
Country	:	US
Telephone Number	:	817-939-7884
Fax Number	:	682-647-0464

Provider Business Practice Location Address
First Line	:	2707 AIRPORT FWY
Second Line	:	SUITE 224
City	:	FORT WORTH
State	:	TX
Zip	:	76111-2370
Country	:	US
Telephone Number	:	817-939-7884
Fax Number	:	682-647-0464

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

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/08/2007

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