MEDICARE: JESSICA MIELKE MSW

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1194122325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MIELKE MSW

Provider Business Mailing Address
First Line	:	68 ELATI ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80223-1542
Country	:	US
Telephone Number	:	614-202-7049
Fax Number	:

Provider Business Practice Location Address
First Line	:	68 ELATI ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80223-1542
Country	:	US
Telephone Number	:	614-202-7049
Fax Number	:

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

Provider Enumeration Date	:	12/03/2014
Last Update Date	:	12/03/2014

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