MEDICARE: JYOTI WADHWA

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	17961	MN

General Provider Information

NPI Number	:	1518791334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JYOTI WADHWA

Provider Business Mailing Address
First Line	:	15815 FRANKLIN TRL SE STE 301
Second Line	:
City	:	PRIOR LAKE
State	:	MN
Zip	:	55372-5505
Country	:	US
Telephone Number	:	952-592-2955
Fax Number	:	800-587-2859

Provider Business Practice Location Address
First Line	:	15815 FRANKLIN TRL SE STE 301
Second Line	:
City	:	SHAKOPEE
State	:	MN
Zip	:	55372-5505
Country	:	US
Telephone Number	:	952-592-2955
Fax Number	:	800-587-2859

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

Provider Enumeration Date	:	08/26/2024
Last Update Date	:	02/12/2026

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