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NPI Code Detail

MEDICARE: JILL LYNN BUMGARDNER LCSW

MEDICARE: JILL LYNN BUMGARDNER LCSW
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 WorkerC012584NC

General Provider Information

NPI Number : 1609398106
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL LYNN BUMGARDNER LCSW
Provider Business Mailing Address
First Line : 200 E 2ND AVE
Second Line :
City : GASTONIA
State : NC
Zip : 28052-4358
Country : US
Telephone Number : 704-874-1904
Fax Number : 704-874-0707
Provider Business Practice Location Address
First Line : 3050 RIVERWOOD PKWY STE B
Second Line :
City : GASTONIA
State : NC
Zip : 28056-6002
Country : US
Telephone Number : 704-874-9005
Fax Number : 704-874-9001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2017
Last Update Date : 11/17/2025

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