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NPI Code Detail

MEDICARE: JENNIFER ANN STEPHENS

MEDICARE: JENNIFER ANN STEPHENS
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
1101YP2500XProfessional Counselor1519KY
2103K00000XBehavior Analyst163696KY

General Provider Information

NPI Number : 1780699371
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER ANN STEPHENS
Provider Business Mailing Address
First Line : 998 BROOKS INDUSTRIAL RD
Second Line :
City : SHELBYVILLE
State : KY
Zip : 40065-8154
Country : US
Telephone Number : 502-633-1315
Fax Number : 502-633-1316
Provider Business Practice Location Address
First Line : 998 BROOKS INDUSTRIAL RD
Second Line :
City : SHELBYVILLE
State : KY
Zip : 40065-8154
Country : US
Telephone Number : 502-633-1315
Fax Number : 502-633-1316
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2006
Last Update Date : 10/05/2020

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Directions to “ JENNIFER ANN STEPHENS ” Practice Location

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