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NPI Code Detail

MEDICARE: JENNIFER RAYNE DEVORE LCSW

MEDICARE: JENNIFER RAYNE DEVORE 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 Worker257782KY

General Provider Information

NPI Number : 1336561083
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER RAYNE DEVORE LCSW
Provider Business Mailing Address
First Line : 570 E MARKS RIDGE RD
Second Line :
City : GARFIELD
State : KY
Zip : 40140-5236
Country : US
Telephone Number : 502-741-7995
Fax Number :
Provider Business Practice Location Address
First Line : 9850 VON ALLMEN CT STE 201
Second Line :
City : LOUISVILLE
State : KY
Zip : 40241-2855
Country : US
Telephone Number : 270-975-2980
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2014
Last Update Date : 04/16/2024

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