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General NPI Number Information
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NPI Number | 1104275353
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Entity Type | Organization
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Legal Business Name | JENNIFER LYNN GREENUP
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Dates
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Enumeration Date | 06/08/2016
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Last Update Date | 06/08/2016
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Provider Practice Location Address
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Address Line | 330 S CENTER ST SUITE 305
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City | CASPER
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State | WY
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Zip | 82601-2840
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Country | US
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Telephone | 307-277-6473
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Fax | 888-659-0934
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Provider Business Mailing Address
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Address Line | PO BOX 51364
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City | CASPER
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State | WY
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Zip | 82605-1364
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Country | US
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Telephone | 307-247-3901
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Fax | 888-659-0934
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JENNFER LYNN GREENUP
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Credential | LCSW
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Telephone | 307-247-3901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 609
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License Number State | WY
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