MEDICARE: JESSICA REDDIN

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	58519	TX

General Provider Information

NPI Number	:	1801379573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA REDDIN

Provider Business Mailing Address
First Line	:	PO BOX 747
Second Line	:
City	:	TERRELL
State	:	TX
Zip	:	75160-0014
Country	:	US
Telephone Number	:	972-524-4159
Fax Number	:	972-524-1002

Provider Business Practice Location Address
First Line	:	655 AIRPORT RD
Second Line	:
City	:	SULPHUR SPRINGS
State	:	TX
Zip	:	75482-2009
Country	:	US
Telephone Number	:	903-438-3270
Fax Number	:	903-438-3280

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

Provider Enumeration Date	:	09/10/2018
Last Update Date	:	09/10/2018

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Directions to “ JESSICA REDDIN ” Practice Location

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