MEDICARE: MRS. TRACEY LYNN JONES ASW

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	104100000X	Social Worker	ASW 24487	CA

General Provider Information

NPI Number	:	1427293455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRACEY LYNN JONES ASW

Provider Business Mailing Address
First Line	:	4564 CASA DEL SOL CT
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92154-4846
Country	:	US
Telephone Number	:	619-651-0253
Fax Number	:

Provider Business Practice Location Address
First Line	:	4564 CASA DEL SOL CT
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92154-4846
Country	:	US
Telephone Number	:	619-651-0253
Fax Number	:

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

Provider Enumeration Date	:	12/04/2008
Last Update Date	:	12/04/2008

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