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General NPI Number Information
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NPI Number | 1619775640
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Entity Type | Organization
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Legal Business Name | JENNIFER SHANKS, LCSW, LCADC
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Dates
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Enumeration Date | 03/05/2025
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 161 SAINT MATTHEWS AVE STE 18
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City | LOUISVILLE
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State | KY
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Zip | 40207-3145
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Country | US
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Telephone | 502-548-5647
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Fax |
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Provider Business Mailing Address
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Address Line | 907 BROADFIELDS DR
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City | LOUISVILLE
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State | KY
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Zip | 40207-4341
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Country | US
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Telephone | 502-548-5647
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER SHANKS
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Credential | LCSW, LCADC
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Telephone | 502-548-5647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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