Healthcare Provider Details

I. General information

NPI: 1962471219
Provider Name (Legal Business Name): JENNIFER ANN MCCOOL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 WASHINGTON AVE STE 300
EVANSVILLE IN
47714-0900
US

IV. Provider business mailing address

4411 WASHINGTON AVE STE 300
EVANSVILLE IN
47714-0900
US

V. Phone/Fax

Practice location:
  • Phone: 812-479-1916
  • Fax: 812-479-5014
Mailing address:
  • Phone: 812-479-1916
  • Fax: 812-479-5014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34003926A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: