MEDICARE: JENNETTE EILEEN STONE 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	104100000X	Social Worker

General Provider Information

NPI Number	:	1780991356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNETTE EILEEN STONE LCSW

Provider Business Mailing Address
First Line	:	4829 W ODELL DR
Second Line	:
City	:	WEST VALLEY
State	:	UT
Zip	:	84120-2918
Country	:	US
Telephone Number	:	385-832-8518
Fax Number	:

Provider Business Practice Location Address
First Line	:	4829 W ODELL DR
Second Line	:
City	:	WEST VALLEY
State	:	UT
Zip	:	84120-2918
Country	:	US
Telephone Number	:	385-832-8518
Fax Number	:

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

Provider Enumeration Date	:	09/02/2010
Last Update Date	:	08/14/2024

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