Provider Demographics
NPI:1093116469
Name:JENNETTE, CHASE KENNETH (LCSW)
Entity Type:Individual
Prefix:
First Name:CHASE
Middle Name:KENNETH
Last Name:JENNETTE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4523 OZARK LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-6916
Mailing Address - Country:US
Mailing Address - Phone:702-776-0052
Mailing Address - Fax:
Practice Address - Street 1:4523 OZARK LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46239-6916
Practice Address - Country:US
Practice Address - Phone:702-776-0052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34009335A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical