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NPI Code Detail

MEDICARE: JESSICA LYNN MARTIN MSSA, LISW

MEDICARE: JESSICA LYNN MARTIN MSSA, LISW
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
11041C0700XClinical Social WorkerI.1501284OH

General Provider Information

NPI Number : 1568822948
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA LYNN MARTIN MSSA, LISW
Provider Business Mailing Address
First Line : 12041 RAVENNA RD
Second Line :
City : CHARDON
State : OH
Zip : 44024-7008
Country : US
Telephone Number : 440-286-7154
Fax Number : 440-286-1037
Provider Business Practice Location Address
First Line : 12041 RAVENNA RD
Second Line :
City : CHARDON
State : OH
Zip : 44024-7008
Country : US
Telephone Number : 440-286-7154
Fax Number : 440-286-1037
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/29/2016
Last Update Date : 02/29/2016

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