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NPI Code Detail

MEDICARE: MS. JENNE K BRDLIK LMSW

MEDICARE: MS. JENNE K BRDLIK LMSW
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
1104100000XSocial WorkerLMSW-12616AZ

General Provider Information

NPI Number : 1447493200
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JENNE K BRDLIK LMSW
Provider Business Mailing Address
First Line : PO BOX 579
Second Line :
City : SAINT JOHNS
State : AZ
Zip : 85936-0579
Country : US
Telephone Number : 928-333-2683
Fax Number : 928-333-5595
Provider Business Practice Location Address
First Line : 470 WEST CLEVELAND
Second Line :
City : SAINT JOHNS
State : AZ
Zip : 85936-0579
Country : US
Telephone Number : 928-337-4301
Fax Number : 928-337-2269
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/09/2009
Last Update Date : 04/09/2009

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