Healthcare Provider Details

I. General information

NPI: 1366376188
Provider Name (Legal Business Name): JENNIE TAGGART LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 VIRGINIA AVE
INDIANAPOLIS IN
46204-3709
US

IV. Provider business mailing address

220 VIRGINIA AVE
INDIANAPOLIS IN
46204-3709
US

V. Phone/Fax

Practice location:
  • Phone: 347-537-8743
  • Fax: 347-537-8743
Mailing address:
  • Phone: 347-537-8743
  • Fax: 347-537-8743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: