MEDICARE: JAYNA BACZWASKI

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	1115	NE

General Provider Information

NPI Number	:	1447576459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYNA BACZWASKI

Provider Business Mailing Address
First Line	:	16615 YORT AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68116-2945
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11605 W DODGE RD STE 4
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-2566
Country	:	US
Telephone Number	:	402-881-6050
Fax Number	:

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

Provider Enumeration Date	:	04/15/2010
Last Update Date	:	11/04/2019

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Directions to “ JAYNA BACZWASKI ” Practice Location

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