MEDICARE: MRS. JENNIFER S O'LOUGHLIN LCSW

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	101YM0800X	Mental Health Counselor	1387	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	610444704	OTHER	KY	TAX ID

General Provider Information

NPI Number	:	1174621072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER S O'LOUGHLIN LCSW

Provider Business Mailing Address
First Line	:	9700 PARK PLAZA AVE UNIT 105
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40241-2286
Country	:	US
Telephone Number	:	502-802-1691
Fax Number	:	502-426-4902

Provider Business Practice Location Address
First Line	:	9700 PARK PLAZA AVE UNIT 105
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40241-2286
Country	:	US
Telephone Number	:	502-802-1691
Fax Number	:	502-426-4902

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	12/29/2019

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Directions to “ MRS. JENNIFER S O'LOUGHLIN LCSW” Practice Location

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