MEDICARE: JESSICA LEIGH SWINNEA LMSW

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	114979	TX

General Provider Information

NPI Number	:	1770393514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LEIGH SWINNEA LMSW

Provider Business Mailing Address
First Line	:	PO BOX 2235
Second Line	:
City	:	ATHENS
State	:	TX
Zip	:	75751-7235
Country	:	US
Telephone Number	:	903-203-9324
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 S PALESTINE ST STE 201
Second Line	:
City	:	ATHENS
State	:	TX
Zip	:	75751-3323
Country	:	US
Telephone Number	:	903-203-9324
Fax Number	:

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

Provider Enumeration Date	:	01/13/2025
Last Update Date	:	01/13/2025

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