MEDICARE: JESSICA IRWIN MSW

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	SC61340115	WA
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1811406572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA IRWIN MSW

Provider Business Mailing Address
First Line	:	1200 LAKEWAY DR STE 8
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98229-2034
Country	:	US
Telephone Number	:	360-553-1007
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 LAKEWAY DR STE 8
Second Line	:
City	:	BELLINGHAM
State	:	WA
Zip	:	98229-2034
Country	:	US
Telephone Number	:	360-553-1007
Fax Number	:

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

Provider Enumeration Date	:	09/26/2017
Last Update Date	:	05/14/2024

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