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Individual
MR. JESSE LANDIS
Active
Individual
MR. JESSE LANDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
SW7171
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SW7171
PROFESSIONAL LICENSE
FL
Enumeration date
01/07/2008
Last updated
05/07/2008
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