Provider Demographics
NPI:1205927795
Name:DAVIS, JON DANIEL (MSW, LCSW, LICSW)
Entity type:Individual
Prefix:MR
First Name:JON
Middle Name:DANIEL
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MSW, LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USAMEDDAC WUERZBURG, ATTN: CREDENTIALS OFFICE
Mailing Address - Street 2:UNIT 26610
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09244-6610
Mailing Address - Country:DE
Mailing Address - Phone:01149931-804-3616
Mailing Address - Fax:01149931-804-3241
Practice Address - Street 1:USAMEDDAC WUERZBURG, ATTN: CREDENTIALS OFFICE
Practice Address - Street 2:UNIT 26610
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09244-6610
Practice Address - Country:DE
Practice Address - Phone:01149931-804-3616
Practice Address - Fax:01149931-804-3241
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT120298-35011041C0700X
WALW000061721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN