MEDICARE: MRS. JENIFER CREPPEL CASS

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	171M00000X	Case Manager/Care Coordinator
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1184994279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENIFER CREPPEL CASS

Provider Business Mailing Address
First Line	:	47285 PALM DR
Second Line	:
City	:	TICKFAW
State	:	LA
Zip	:	70466-4211
Country	:	US
Telephone Number	:	985-543-4730
Fax Number	:	985-543-4752

Provider Business Practice Location Address
First Line	:	47285 PALM DR
Second Line	:
City	:	TICKFAW
State	:	LA
Zip	:	70466-4211
Country	:	US
Telephone Number	:	985-543-4730
Fax Number	:	985-543-4752

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

Provider Enumeration Date	:	01/05/2012
Last Update Date	:	04/13/2016

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