Individual
MS. JENNIFER KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
441 E BROAD ST, SUITE J, COOKEVILLE, TN 38501
(931) 520-0736
(931) 520-0743
Mailing address
441 E BROAD ST, SUITE J, COOKEVILLE, TN 38501
(931) 520-0736
(931) 520-0743
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LSW 0000004162
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3926505
—
TN
01
—
4069908
BLUE CROSS
TN
Enumeration date
08/16/2006
Last updated
07/08/2007
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