MEDICARE: MRS. JUANITA SERENA ELLIOTT LMSW

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	278361	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922130376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUANITA SERENA ELLIOTT LMSW

Provider Business Mailing Address
First Line	:	PO BOX 141795
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99514-1795
Country	:	US
Telephone Number	:	907-569-5033
Fax Number	:	907-569-5033

Provider Business Practice Location Address
First Line	:	4034 REKA L5
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508
Country	:	US
Telephone Number	:	907-569-5033
Fax Number	:	907-569-5033

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	07/08/2007

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