Healthcare Provider Details

I. General information

NPI: 1134126782
Provider Name (Legal Business Name): JILLORNA ANN UCENY MSW, ACSW, LCSW, BCD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 N MICHIGAN ST STE 208
PLYMOUTH IN
46563-1753
US

IV. Provider business mailing address

310 N MICHIGAN ST STE 208
PLYMOUTH IN
46563-1753
US

V. Phone/Fax

Practice location:
  • Phone: 574-935-9449
  • Fax: 574-935-3956
Mailing address:
  • Phone: 574-935-9449
  • Fax: 574-935-3956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number34000107A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: