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1104324573 NPI number — JENNY LYNNE KEENE LCSW

NPI Number: 1104324573
Health Care Provider/Practitioner: JENNY LYNNE KEENE LCSW

Information about “1104324573” NPI (JENNY LYNNE KEENE LCSW) exists in 1104324573 in HTML format HTML  |  1104324573 in plain Text format TXT  |  1104324573 in PDF (Portable Document Format) PDF  |  1104324573 in an XML format XML  formats.

NPI Number : 1104324573 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104324573",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KEENE",
    "FirstName": "JENNY",
    "MiddleName": "LYNNE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "LATHUM",
    "OtherFirstName": "JENNY",
    "OtherMiddleName": "LYNNE",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "402 S SILVER SPRINGS RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CAPE GIRARDEAU",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63703-7536",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "573-334-1100",
    "MailingAddressFaxNumber": "573-651-4345",
    "FirstLinePracticeLocationAddress": "103 EL NATHAN DRIVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MARBLE HILL",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "63764-8342",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "573-238-1027",
    "PracticeLocationAddressFaxNumber": "573-238-1171",
    "EnumerationDate": "01/31/2018",
    "LastUpdateDate": "09/12/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "104100000X",
          "TaxonomyName": "Social Worker",
          "LicenseNumber": "2015037534",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "218042356",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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