MEDICARE: MRS. JILLIAN WHITE 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	171M00000X	Case Manager/Care Coordinator
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1881349488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JILLIAN WHITE LSW

Provider Business Mailing Address
First Line	:	673 BARRINGTON RD
Second Line	:
City	:	COLLEGEVILLE
State	:	PA
Zip	:	19426-3406
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	673 BARRINGTON RD
Second Line	:
City	:	COLLEGEVILLE
State	:	PA
Zip	:	19426-3406
Country	:	US
Telephone Number	:	717-599-1316
Fax Number	:

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

Provider Enumeration Date	:	02/14/2022
Last Update Date	:	02/14/2022

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