MEDICARE: SARAH J JOLIN LISW

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	05693	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265520985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH J JOLIN LISW

Provider Business Mailing Address
First Line	:	2501 PIERCE ST
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-3725
Country	:	US
Telephone Number	:	712-294-5000
Fax Number	:	712-294-5091

Provider Business Practice Location Address
First Line	:	2912 HAMILTON BLVD STE 105
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-2423
Country	:	US
Telephone Number	:	712-224-0122
Fax Number	:	712-224-0123

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	06/09/2020

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