MEDICARE: MRS. JILLORNA ANN UCENY MSW, ACSW, LCSW, BCD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	34000107A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134126782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JILLORNA ANN UCENY MSW, ACSW, LCSW, BCD

Provider Business Mailing Address
First Line	:	310 N MICHIGAN ST
Second Line	:	STE 208
City	:	PLYMOUTH
State	:	IN
Zip	:	46563-1753
Country	:	US
Telephone Number	:	574-935-9449
Fax Number	:	574-935-3956

Provider Business Practice Location Address
First Line	:	310 N MICHIGAN ST
Second Line	:	STE 208
City	:	PLYMOUTH
State	:	IN
Zip	:	46563-1753
Country	:	US
Telephone Number	:	574-935-9449
Fax Number	:	574-935-3956

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	01/20/2011

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