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NPI Code Detail

MEDICARE: MS. JACQUELYN GANUS LCSW

MEDICARE: MS. JACQUELYN GANUS LCSW
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
11041C0700XClinical Social Worker1397CAL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11397COTHERALCERTIFIED SOCIAL WORKER

General Provider Information

NPI Number : 1154359164
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JACQUELYN GANUS LCSW
Provider Business Mailing Address
First Line : 514 COUNCIL BLUFF PKWY
Second Line :
City : MURFREESBORO
State : TN
Zip : 37127-6389
Country : US
Telephone Number : 615-225-5377
Fax Number :
Provider Business Practice Location Address
First Line : 1801 W END AVE
Second Line :
City : NASHVILLE
State : TN
Zip : 37203-2526
Country : US
Telephone Number : 615-965-2199
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2006
Last Update Date : 03/09/2012

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