Provider Demographics
NPI:1225261308
Name:BYORUM, JENA J (LISW)
Entity Type:Individual
Prefix:MS
First Name:JENA
Middle Name:J
Last Name:BYORUM
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:JENA
Other - Middle Name:J
Other - Last Name:GASKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2010 E 38TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-1163
Mailing Address - Country:US
Mailing Address - Phone:563-349-5176
Mailing Address - Fax:563-726-7473
Practice Address - Street 1:2010 E 38TH ST STE 103
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-1163
Practice Address - Country:US
Practice Address - Phone:563-349-5176
Practice Address - Fax:563-355-1660
Is Sole Proprietor?:No
Enumeration Date:2009-08-24
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0069881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA42-0716337Medicaid
074520029Medicare PIN