Healthcare Provider Details

I. General information

NPI: 1073169926
Provider Name (Legal Business Name): JOBS FOR KENTUCKY'S GRADUATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 11/10/2024
Certification Date: 11/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 HARRODSBURG RD STE B330
LEXINGTON KY
40504-3389
US

IV. Provider business mailing address

2365 HARRODSBURG RD STE B330
LEXINGTON KY
40504-3389
US

V. Phone/Fax

Practice location:
  • Phone: 859-407-3479
  • Fax:
Mailing address:
  • Phone: 859-407-3479
  • Fax:

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: CAMILLE BROOKE ROBIDOUX
Title or Position: MEDICAID MANAGER
Credential: LCSW
Phone: 606-594-2989