=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427079409
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOYCE M JENNINGS LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2006
-----------------------------------------------------
Last Update Date | 03/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8340 LITTLE EAGLE CT # A
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46234-3816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-271-8700
-----------------------------------------------------
Fax | 317-271-8790
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8340 LITTLE EAGLE CT # A
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46234-3816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-271-8700
-----------------------------------------------------
Fax | 317-271-8790
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 34000221A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------