MEDICARE: MRS. JENNIFER R. ORDONEZ 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
1	1041C0700X	Clinical Social Worker	C005864	NC

General Provider Information

NPI Number	:	1720269665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER R. ORDONEZ LCSW

Provider Business Mailing Address
First Line	:	PO BOX 10399
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28404-0399
Country	:	US
Telephone Number	:	910-675-3533
Fax Number	:	910-675-3405

Provider Business Practice Location Address
First Line	:	5000 LAMBS PATH WAY
Second Line	:
City	:	CASTLE HAYNE
State	:	NC
Zip	:	28429-6311
Country	:	US
Telephone Number	:	910-675-3533
Fax Number	:	910-675-3405

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

Provider Enumeration Date	:	11/20/2007
Last Update Date	:	11/20/2007

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