1992847909 NPI number — MRS. JENNIFER GRACE ALBRIGHT KNASH DAT, ATRL, LPC/AODA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992847909 NPI number — MRS. JENNIFER GRACE ALBRIGHT KNASH DAT, ATRL, LPC/AODA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALBRIGHT KNASH
Provider First Name:
JENNIFER
Provider Middle Name:
GRACE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DAT, ATRL, LPC/AODA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALBRIGHT
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
G
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DAT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1992847909
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3383 E LAYTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUDAHY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53110-1437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-550-5338
Provider Business Mailing Address Fax Number:
901-877-7991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3383 E LAYTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUDAHY
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53110-1437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-550-5338
Provider Business Practice Location Address Fax Number:
901-877-7991
Provider Enumeration Date:
02/13/2007

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100049329 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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