MEDICARE: MISS JESSICA L BURTON 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	8999-C	NV

General Provider Information

NPI Number	:	1184107906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JESSICA L BURTON LCSW

Provider Business Mailing Address
First Line	:	1607 E WINDMILL LN STE 300
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1910
Country	:	US
Telephone Number	:	702-757-8720
Fax Number	:

Provider Business Practice Location Address
First Line	:	1607 E WINDMILL LN STE 300
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1910
Country	:	US
Telephone Number	:	702-757-8720
Fax Number	:

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

Provider Enumeration Date	:	09/07/2018
Last Update Date	:	08/19/2022

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