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General NPI Number Information
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NPI Number | 1780290247
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Entity Type | Individual
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Provider Name | KRISTEN JALOVECKY LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/21/2020
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Last Update Date | 02/04/2023
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Provider Practice Location Address
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Address Line | 390 PONDELLA RD STE 9
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City | FORT MYERS
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State | FL
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Zip | 33903-4340
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Country | US
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Telephone | 239-652-0260
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Fax |
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Provider Business Mailing Address
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Address Line | 3301 MIAMI ST
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City | KNOXVILLE
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State | TN
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Zip | 37917-2720
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Country | US
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Telephone | 813-570-0365
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW17526
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License Number State | FL
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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 | LSW7771
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License Number State | TN
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