Provider Demographics
NPI:1275623977
Name:DUTTON, JENNIFER HELEN (PSC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:HELEN
Last Name:DUTTON
Suffix:
Gender:F
Credentials:PSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6212 DEEP CREEK CT
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-9344
Mailing Address - Country:US
Mailing Address - Phone:502-290-8313
Mailing Address - Fax:502-290-8305
Practice Address - Street 1:6212 DEEP CREEK CT
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-9344
Practice Address - Country:US
Practice Address - Phone:502-290-8313
Practice Address - Fax:502-290-8305
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator