MEDICARE: JENNIFER AUSTIN LMSW MDIV LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1679404560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER AUSTIN LMSW MDIV LLC

Provider Business Mailing Address
First Line	:	1909 THRUSHWOOD AVE
Second Line	:
City	:	PORTAGE
State	:	MI
Zip	:	49002-5761
Country	:	US
Telephone Number	:	269-330-5755
Fax Number	:

Provider Business Practice Location Address
First Line	:	1611 W CENTRE AVE
Second Line	:
City	:	PORTAGE
State	:	MI
Zip	:	49024-5344
Country	:	US
Telephone Number	:	269-330-5755
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL SOCIAL WORKER/THERAPIST
Name	:	MRS. JENNIFER LYNN AUSTIN
Credential	:	LMSW-C, LISW, LICSW
Telephone Number	:	269-478-9529

Provider Enumeration Date	:	05/28/2026
Last Update Date	:	05/28/2026

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