MEDICARE: JENNIFER POWELL-FOLKS

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
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1972991388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER POWELL-FOLKS

Provider Business Mailing Address
First Line	:	1352 FILLMORE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-5926
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1352 FILLMORE ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19124-5926
Country	:	US
Telephone Number	:	215-744-9170
Fax Number	:

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

Provider Enumeration Date	:	01/07/2015
Last Update Date	:	01/07/2015

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