MEDICARE: JESSICA FLEMING LGSW

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	104100000X	Social Worker	SW102417253	WV

General Provider Information

NPI Number	:	1689497133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA FLEMING LGSW

Provider Business Mailing Address
First Line	:	PO BOX 5621
Second Line	:
City	:	PRINCETON
State	:	WV
Zip	:	24740-5621
Country	:	US
Telephone Number	:	304-223-5200
Fax Number	:

Provider Business Practice Location Address
First Line	:	152 MISTY LN
Second Line	:
City	:	PRINCETON
State	:	WV
Zip	:	24740-6462
Country	:	US
Telephone Number	:	304-223-5200
Fax Number	:

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

Provider Enumeration Date	:	11/04/2024
Last Update Date	:	11/04/2024

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