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General NPI Number Information
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NPI Number | 1518424712
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Entity Type | Individual
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Provider Name | JENNIFER ALINE REYNOLDS CSW
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Gender | Female
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Dates
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Enumeration Date | 02/23/2019
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 420 N LORETTO RD STE 200
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City | LEBANON
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State | KY
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Zip | 40033-1630
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Country | US
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Telephone | 270-321-4480
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 343
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City | ELIZABETHTOWN
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State | KY
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Zip | 42702-0343
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Country | US
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Telephone | 270-506-2730
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 253099
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 257174
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License Number State | KY
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