MEDICARE: MRS. JENNA MOSSNER

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	34009315A	IN
2	1041C0700X	Clinical Social Worker	10139	WI

General Provider Information

NPI Number	:	1851080451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNA MOSSNER

Provider Business Mailing Address
First Line	:	6219 CANYON PKWY
Second Line	:
City	:	MCFARLAND
State	:	WI
Zip	:	53558-8787
Country	:	US
Telephone Number	:	317-645-6959
Fax Number	:

Provider Business Practice Location Address
First Line	:	6219 CANYON PKWY
Second Line	:
City	:	MCFARLAND
State	:	WI
Zip	:	53558-8787
Country	:	US
Telephone Number	:	317-645-6959
Fax Number	:

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

Provider Enumeration Date	:	05/01/2023
Last Update Date	:	05/01/2023

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Directions to “ MRS. JENNA MOSSNER ” Practice Location

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