MEDICARE: JENNIFER RUTH HOODECHECKJ LCSW, MAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	1041C0700X	Clinical Social Worker	CSW005887	GA

General Provider Information

NPI Number	:	1114865060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER RUTH HOODECHECKJ LCSW, MAC

Provider Business Mailing Address
First Line	:	3449 MILL CREEK RD
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30506-1222
Country	:	US
Telephone Number	:	770-503-4708
Fax Number	:

Provider Business Practice Location Address
First Line	:	5355 HUNTER RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-2594
Country	:	US
Telephone Number	:	770-503-4708
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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