MEDICARE: MS. JESSICA RANDAZZO 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	518	MT

General Provider Information

NPI Number	:	1306920400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA RANDAZZO LCSW

Provider Business Mailing Address
First Line	:	1114 SOUTH 4TH STREET
Second Line	:
City	:	HAMILTON
State	:	MT
Zip	:	59840
Country	:	US
Telephone Number	:	406-370-3483
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 N 4TH ST
Second Line	:
City	:	HAMILTON
State	:	MT
Zip	:	59840-2412
Country	:	US
Telephone Number	:	406-370-3483
Fax Number	:

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	12/20/2016

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