Provider Demographics
NPI:1124391438
Name:VICKERS, JENNIFER L (MSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:VICKERS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 BROADWAY
Mailing Address - Street 2:SUITE F1
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-8602
Mailing Address - Country:US
Mailing Address - Phone:219-736-1000
Mailing Address - Fax:219-736-9699
Practice Address - Street 1:8300 BROADWAY
Practice Address - Street 2:SUITE F1
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-8602
Practice Address - Country:US
Practice Address - Phone:219-736-1000
Practice Address - Fax:219-736-9699
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical