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NPI Code Detail

MEDICARE: JORDAN KIELISZEWSKI LISWS

MEDICARE: JORDAN KIELISZEWSKI LISWS
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 WorkerS32150OH

General Provider Information

NPI Number : 1669469094
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDAN KIELISZEWSKI LISWS
Provider Business Mailing Address
First Line : 7300 N PERIMETER RD
Second Line :
City : MALMSTROM AFB
State : MT
Zip : 59402-6701
Country : US
Telephone Number : 406-731-3219
Fax Number :
Provider Business Practice Location Address
First Line : 7300 N PERIMETER RD
Second Line :
City : MALMSTROM AFB
State : MT
Zip : 59402-6701
Country : US
Telephone Number : 64-731-4494
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2005
Last Update Date : 09/22/2022

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Directions to “ JORDAN KIELISZEWSKI LISWS” Practice Location

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