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NPI Code Detail

MEDICARE: JENNIFER M WHITAKER

MEDICARE: JENNIFER M WHITAKER
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
11041C0700XClinical Social Worker34010763AIN

General Provider Information

NPI Number : 1245005792
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER M WHITAKER
Provider Business Mailing Address
First Line : PO BOX 775383
Second Line :
City : CHICAGO
State : IL
Zip : 60677-5383
Country : US
Telephone Number : 812-376-5315
Fax Number :
Provider Business Practice Location Address
First Line : 2630 22ND ST
Second Line :
City : COLUMBUS
State : IN
Zip : 47201-3702
Country : US
Telephone Number : 812-375-3784
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/15/2023
Last Update Date : 09/06/2024

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Directions to “ JENNIFER M WHITAKER ” Practice Location

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