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NPI Code Detail

MEDICARE: JESSICA L SOUKUP LCSW

MEDICARE: JESSICA L SOUKUP 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
11041C0700XClinical Social Worker4690-CNV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14960-COTHERNVSTATE LICENSE

General Provider Information

NPI Number : 1326270042
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA L SOUKUP LCSW
Provider Business Mailing Address
First Line : 1064 RIDGEFIELD DR
Second Line :
City : CARSON CITY
State : NV
Zip : 89706-4372
Country : US
Telephone Number : 775-720-8676
Fax Number : 775-418-7636
Provider Business Practice Location Address
First Line : 407 N WALSH ST
Second Line :
City : CARSON CITY
State : NV
Zip : 89701-4268
Country : US
Telephone Number : 775-720-8676
Fax Number : 775-418-7636
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2009
Last Update Date : 12/02/2022

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Directions to “ JESSICA L SOUKUP LCSW” Practice Location

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