Healthcare Provider Details

I. General information

NPI: 1952919524
Provider Name (Legal Business Name): JENNIFER LYNN KRACIUM LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER LYNN MYERS

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 CARDINAL CT
AUBURN IN
46706-2678
US

IV. Provider business mailing address

2621 E JEFFERSON ST
WARSAW IN
46580-3880
US

V. Phone/Fax

Practice location:
  • Phone: 574-385-3136
  • Fax: 260-925-8034
Mailing address:
  • Phone: 800-342-5653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34010598A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: