Provider Demographics
NPI:1457845737
Name:HAMILTON, JENNIFER JO (LBSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JO
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 EMPIRE CENTRAL DR STE 260
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4322
Mailing Address - Country:US
Mailing Address - Phone:214-432-8296
Mailing Address - Fax:214-203-0803
Practice Address - Street 1:1140 EMPIRE CENTRAL DR STE 260
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4322
Practice Address - Country:US
Practice Address - Phone:214-432-8296
Practice Address - Fax:214-203-0803
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65627171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX311513101Medicaid