MEDICARE: IANA JENNIEK SIMMONS

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	1041S0200X	School Social Worker		VA

General Provider Information

NPI Number	:	1710857388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IANA JENNIEK SIMMONS

Provider Business Mailing Address
First Line	:	105 W BANK ST
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-3215
Country	:	US
Telephone Number	:	804-331-1138
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 W BANK ST
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-3215
Country	:	US
Telephone Number	:	804-331-1138
Fax Number	:

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

Provider Enumeration Date	:	11/10/2025
Last Update Date	:	11/10/2025

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