MEDICARE: JESSICA LYNN MARTIN LSW

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	33013219A	IN

General Provider Information

NPI Number	:	1801772066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LYNN MARTIN LSW

Provider Business Mailing Address
First Line	:	3761 ASHLEY OAKS DR
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-6024
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3761 ASHLEY OAKS DR
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-6024
Country	:	US
Telephone Number	:	765-615-7856
Fax Number	:

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

Provider Enumeration Date	:	08/13/2025
Last Update Date	:	08/13/2025

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