MEDICARE: JESSICA GIFFIN

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1477278984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA GIFFIN

Provider Business Mailing Address
First Line	:	42481 ROCKROSE SQ UNIT 303
Second Line	:
City	:	BRAMBLETON
State	:	VA
Zip	:	20148-4817
Country	:	US
Telephone Number	:	802-683-7665
Fax Number	:

Provider Business Practice Location Address
First Line	:	10427 NORTH ST STE 201
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-2592
Country	:	US
Telephone Number	:	571-293-1318
Fax Number	:

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

Provider Enumeration Date	:	10/06/2022
Last Update Date	:	10/06/2022

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Directions to “ JESSICA GIFFIN ” Practice Location

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