MEDICARE: LAUREN KAYE KETCHIE 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	1041C0700X	Clinical Social Worker	SW23439	FL

General Provider Information

NPI Number	:	1497687255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN KAYE KETCHIE LCSW

Provider Business Mailing Address
First Line	:	10140 CENTURION PKWY N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-0532
Country	:	US
Telephone Number	:	904-697-4100
Fax Number	:

Provider Business Practice Location Address
First Line	:	841 PRUDENTIAL DR STE 300
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-8329
Country	:	US
Telephone Number	:	904-697-3600
Fax Number	:

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

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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