Individual
JANE BURGESS WALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
60 PROFESSIONAL PARK DR, LOUISA, KY 41230-9644
(606) 638-4332
(606) 638-4394
Mailing address
PO BOX 790, ASHLAND, KY 41105-0790
(606) 329-8588
(606) 329-8195
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
KY-1263
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000207306
ANTHEM BCBS
KY
01
—
001723358
MSBCBS
—
01
—
11491126
CAQH #
—
01
—
1175490
CHA
—
01
—
279403
MANAGED HEALTH
—
01
—
610661987
CORPHEALTH
—
05
—
7100282900
—
KY
Enumeration date
07/17/2006
Last updated
11/07/2014
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