MEDICARE: MS. JENNIFER LYNN THOMAS 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	7432	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7432	OTHER	TN	STATE LICENSE

General Provider Information

NPI Number	:	1568769313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER LYNN THOMAS LCSW

Provider Business Mailing Address
First Line	:	PO BOX 10901
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46854-0901
Country	:	US
Telephone Number	:	574-546-1900
Fax Number	:	574-546-1999

Provider Business Practice Location Address
First Line	:	6000 POPLAR AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38119-3981
Country	:	US
Telephone Number	:	574-546-1900
Fax Number	:	574-546-1999

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

Provider Enumeration Date	:	02/14/2011
Last Update Date	:	03/14/2024

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