MEDICARE: MS. JESSICA JOY SIEWERT CHW II

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	225400000X	Rehabilitation Practitioner
2	172V00000X	Community Health Worker	CHW25035	NV

General Provider Information

NPI Number	:	1922634880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA JOY SIEWERT CHW II

Provider Business Mailing Address
First Line	:	250 AUTUMN EVE ST
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89074-7837
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3776 HOWARD HUGHES PKWY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89169-0937
Country	:	US
Telephone Number	:	702-245-0499
Fax Number	:

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

Provider Enumeration Date	:	03/22/2020
Last Update Date	:	08/18/2022

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