Provider Demographics
NPI:1003312463
Name:DUVALL, JENNIFER NICOLE (MSSW, LSW)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:NICOLE
Last Name:DUVALL
Suffix:
Gender:F
Credentials:MSSW, LSW
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:NICOLE
Other - Last Name:GORETCKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSSW, LSW
Mailing Address - Street 1:705 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-4101
Mailing Address - Country:US
Mailing Address - Phone:502-387-2292
Mailing Address - Fax:
Practice Address - Street 1:7509 CHARLESTOWN PIKE
Practice Address - Street 2:
Practice Address - City:CHARLESTOWN
Practice Address - State:IN
Practice Address - Zip Code:47111-9623
Practice Address - Country:US
Practice Address - Phone:812-256-4686
Practice Address - Fax:812-256-4415
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IN33009095A1041C0700X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical