Provider Demographics
NPI:1477885531
Name:MAGGARD, JENNIFER ERIN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ERIN
Last Name:MAGGARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2346 S LYNHURST DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-8621
Mailing Address - Country:US
Mailing Address - Phone:317-502-6572
Mailing Address - Fax:
Practice Address - Street 1:2346 S LYNHURST DR
Practice Address - Street 2:SUITE 101
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-8621
Practice Address - Country:US
Practice Address - Phone:317-502-6572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-31
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004761A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical