MEDICARE: MS. JENNIFER ANN CARLSON 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	011099	CT
2	1041C0700X	Clinical Social Worker	BBH-LCSW-LIC-58544	MT
3	1041C0700X	Clinical Social Worker	080179	NY

General Provider Information

NPI Number	:	1730314493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER ANN CARLSON LCSW

Provider Business Mailing Address
First Line	:	5108 VILLAGE VIEW WAY APT 7
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59803-3400
Country	:	US
Telephone Number	:	917-769-9609
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 N HIGGINS AVE STE 204.2B
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59802-4437
Country	:	US
Telephone Number	:	917-769-9609
Fax Number	:

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

Provider Enumeration Date	:	05/26/2009
Last Update Date	:	12/03/2025

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