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1255215984 NPI number — JEANIE LYN JEFFERSON LCSW

NPI Number: 1255215984
Health Care Provider/Practitioner: JEANIE LYN JEFFERSON LCSW

Information about “1255215984” NPI (JEANIE LYN JEFFERSON LCSW) exists in 1255215984 in HTML format HTML  |  1255215984 in plain Text format TXT  |  1255215984 in PDF (Portable Document Format) PDF  |  1255215984 in an XML format XML  formats.

NPI Number : 1255215984 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1255215984",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JEFFERSON",
    "FirstName": "JEANIE",
    "MiddleName": "LYN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "JENICKE",
    "OtherFirstName": "JEANIE",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LCSW",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "14 S WILLSON AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BOZEMAN",
    "MailingAddressStateName": "MT",
    "MailingAddressPostalCode": "59715-6232",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "804-215-6803",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1708 ARBOR MILL CIR APT 1112",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BEDFORD",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "76021-1808",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "817-690-0053",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/05/2025",
    "LastUpdateDate": "08/05/2025",
    "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": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "106913",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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