MEDICARE: JESSICA GLAB APSW

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	130532121	WI
2	1041C0700X	Clinical Social Worker	10002-123	WI

General Provider Information

NPI Number	:	1821524166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA GLAB APSW

Provider Business Mailing Address
First Line	:	1926 N GREEN BAY RD
Second Line	:
City	:	GRAFTON
State	:	WI
Zip	:	53024-9644
Country	:	US
Telephone Number	:	414-254-8403
Fax Number	:

Provider Business Practice Location Address
First Line	:	1245 CHEYENNE AVE STE 200
Second Line	:
City	:	GRAFTON
State	:	WI
Zip	:	53024-9323
Country	:	US
Telephone Number	:	414-254-8403
Fax Number	:

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

Provider Enumeration Date	:	05/05/2017
Last Update Date	:	05/08/2025

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Directions to “ JESSICA GLAB APSW” Practice Location

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