MEDICARE: MARGARET M DI JACKLIN LCSW

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	13905	TX

General Provider Information

NPI Number	:	1992757207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET M DI JACKLIN LCSW

Provider Business Mailing Address
First Line	:	17625 EL CAMINO REAL
Second Line	:	160
City	:	HOUSTON
State	:	TX
Zip	:	77058-3052
Country	:	US
Telephone Number	:	281-798-9362
Fax Number	:	281-286-0041

Provider Business Practice Location Address
First Line	:	17625 EL CAMINO REAL
Second Line	:	160
City	:	HOUSTON
State	:	TX
Zip	:	77058-3052
Country	:	US
Telephone Number	:	281-798-9362
Fax Number	:	281-286-0041

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	07/08/2007

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