Healthcare Provider Details

I. General information

NPI: 1619048246
Provider Name (Legal Business Name): JENNIFER ANN CURTIS MSW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER ANN LILLICH BS

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 RED COACH DR STE E
MISHAWAKA IN
46545-8324
US

IV. Provider business mailing address

113 LINCOLNWAY E
MISHAWAKA IN
46544-2016
US

V. Phone/Fax

Practice location:
  • Phone: 574-335-7630
  • Fax: 574-335-0841
Mailing address:
  • Phone: 574-255-4976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34005049A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: