Provider Demographics
NPI:1134126782
Name:UCENY, JILLORNA ANN (MSW, ACSW, LCSW, BCD)
Entity Type:Individual
Prefix:MRS
First Name:JILLORNA
Middle Name:ANN
Last Name:UCENY
Suffix:
Gender:F
Credentials:MSW, ACSW, LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N MICHIGAN ST
Mailing Address - Street 2:STE 208
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-1753
Mailing Address - Country:US
Mailing Address - Phone:574-935-9449
Mailing Address - Fax:574-935-3956
Practice Address - Street 1:310 N MICHIGAN ST
Practice Address - Street 2:STE 208
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-1753
Practice Address - Country:US
Practice Address - Phone:574-935-9449
Practice Address - Fax:574-935-3956
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000107A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200095080AMedicaid
IN100114180Medicaid
IN100114180Medicaid