MEDICARE: MISS JODI LEE OHNICK LCHW

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	172V00000X	Community Health Worker	CHW0000000022	AZ

General Provider Information

NPI Number	:	1316648322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JODI LEE OHNICK LCHW

Provider Business Mailing Address
First Line	:	1620 N 61ST DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85035-4804
Country	:	US
Telephone Number	:	602-373-0463
Fax Number	:

Provider Business Practice Location Address
First Line	:	655 S ASH AVE
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85281-2812
Country	:	US
Telephone Number	:	480-350-8004
Fax Number	:

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

Provider Enumeration Date	:	03/15/2023
Last Update Date	:	09/21/2023

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