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NPI Code Detail

MEDICARE: JEAN ANNE SWEETLAND MSW

MEDICARE: JEAN ANNE SWEETLAND MSW
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 Worker352123WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588747810
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEAN ANNE SWEETLAND MSW
Provider Business Mailing Address
First Line : 827 WINFORD AVE
Second Line :
City : GREEN BAY
State : WI
Zip : 54303-4066
Country : US
Telephone Number : 920-494-6046
Fax Number :
Provider Business Practice Location Address
First Line : 1825 RIVERSIDE DR
Second Line :
City : GREEN BAY
State : WI
Zip : 54301-2316
Country : US
Telephone Number : 920-437-7531
Fax Number : 920-437-4067
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/23/2006
Last Update Date : 07/08/2007

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