Provider Demographics
NPI:1467959775
Name:WILLIAMS, JENNIFER DAWN (CSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DAWN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:CAMPBELL, FORESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1143 FAIRWAY STREET
Mailing Address - Street 2:STE 103
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-2452
Mailing Address - Country:US
Mailing Address - Phone:407-347-4536
Mailing Address - Fax:812-285-8392
Practice Address - Street 1:1143 FAIRWAY STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-2452
Practice Address - Country:US
Practice Address - Phone:407-347-4536
Practice Address - Fax:812-285-8392
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical