Individual
MR. JEFFRY DAVID JEANETTA WARK
Active
Individual
MR. JEFFRY DAVID JEANETTA WARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA LICSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
09459
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13GS2WA
BCBS
—
01
—
483889
VALUE OPTIONS
—
Enumeration date
11/20/2006
Last updated
03/21/2018
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