MEDICARE: MS. JENNIFER ANN MADERE LPC

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	:	1255587226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER ANN MADERE LPC

Provider Business Mailing Address
First Line	:	1311 CHISHOLM TRL STE 301
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-2969
Country	:	US
Telephone Number	:	512-762-4762
Fax Number	:	512-248-9833

Provider Business Practice Location Address
First Line	:	1311 CHISHOLM TRL STE 301
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78681-2969
Country	:	US
Telephone Number	:	512-762-4762
Fax Number	:	512-248-9833

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

Provider Enumeration Date	:	08/11/2008
Last Update Date	:	08/11/2008

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