1538248869 NPI number — MRS. JENNIFER ELLEN WILLHOIT LCSW

Table of content: MRS. JENNIFER ELLEN WILLHOIT LCSW (NPI 1538248869)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538248869 NPI number — MRS. JENNIFER ELLEN WILLHOIT LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLHOIT
Provider First Name:
JENNIFER
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FRIERMOOD
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
ELLEN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1538248869
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8212 KENNEDY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGHLAND
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46322-1130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-923-2050
Provider Business Mailing Address Fax Number:
219-923-2050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8212 KENNEDY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HIGHLAND
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46322-1130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-923-2050
Provider Business Practice Location Address Fax Number:
219-923-2050
Provider Enumeration Date:
11/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  34005114A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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