Healthcare Provider Details

I. General information

NPI: 1003984196
Provider Name (Legal Business Name): JENNIFER CAROLYN SKINNER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER CAROLYN SKINNER LCSW

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 NORTH MART PLAZA SUITE M
JACKSON MS
39206
US

IV. Provider business mailing address

1572 SCHOOLVIEW DRIVE
JACKSON MS
39213
US

V. Phone/Fax

Practice location:
  • Phone: 601-362-8850
  • Fax: 601-981-0452
Mailing address:
  • Phone: 601-366-3564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC1277
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: