MEDICARE: JENNIFER DIANN GREEVER LSCSW

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	101YM0800X	Mental Health Counselor	4046	KS
2	1041C0700X	Clinical Social Worker	4046	KS

General Provider Information

NPI Number	:	1205175858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER DIANN GREEVER LSCSW

Provider Business Mailing Address
First Line	:	2001 HASKELL AVE
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66046-3249
Country	:	US
Telephone Number	:	785-302-9976
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 HASKELL AVE
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66046-3249
Country	:	US
Telephone Number	:	785-302-9976
Fax Number	:

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

Provider Enumeration Date	:	02/01/2013
Last Update Date	:	09/02/2020

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