Jackie Brown
Individual provider Active NPI Social Worker · Fountain, SC
NPI 1457719759 · NPPES record last updated Feb 2, 2016
Key facts
- NPI
- 1457719759
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Social Worker 104100000X
- Practice address
- 305 Fork Rd
Fountain, SC 29644-9477 - Phone
- (678) 463-2467
- NPI assigned
- Feb 2, 2016
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | Yes |
Addresses
Primary practice location
305 Fork Rd
Fountain, SC 29644-9477
Mailing address
305 Fork Rd
Fountain Inn, SC 29644-9477
Phone (678) 463-2467
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 2, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.