=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326775206
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA JAGGERS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2022
-----------------------------------------------------
Last Update Date | 08/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 914 E BROADWAY STE 100
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40204-1037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-587-8833
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10401 LINN STATION RD STE 100
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40223-3842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-589-8600
-----------------------------------------------------
Fax | 502-589-8745
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 298981
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------