MEDICARE: JEANNE JENKINS ZUCKER L.C.S.W

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		TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4031301	OTHER	TN	BLUE CROSS NUMBER

General Provider Information

NPI Number	:	1144241316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNE JENKINS ZUCKER L.C.S.W

Provider Business Mailing Address
First Line	:	PO BOX 10647
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37939-0647
Country	:	US
Telephone Number	:	865-588-4044
Fax Number	:

Provider Business Practice Location Address
First Line	:	6906 KINGSTON PIKE
Second Line	:	SUITE 200
City	:	KNOXVILLE
State	:	TN
Zip	:	37919-5704
Country	:	US
Telephone Number	:	865-588-4044
Fax Number	:

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

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	07/08/2007

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