MEDICARE: MS. JENNIFER L BOONE 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	PRC13818	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K708	OTHER	DC	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1396742680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER L BOONE LPC

Provider Business Mailing Address
First Line	:	1410 T ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20009-3906
Country	:	US
Telephone Number	:	202-558-8220
Fax Number	:

Provider Business Practice Location Address
First Line	:	1808 T ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20009-7126
Country	:	US
Telephone Number	:	202-939-0939
Fax Number	:	202-939-0939

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

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	07/08/2007

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