Provider Demographics
NPI:1487040044
Name:ESSEX, JENNY L (MSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:L
Last Name:ESSEX
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1614 N. LEBANON ST.
Mailing Address - Street 2:INTEGRATIVE WELLNESS, LLC
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052
Mailing Address - Country:US
Mailing Address - Phone:765-680-0071
Mailing Address - Fax:765-680-0468
Practice Address - Street 1:1614 N. LEBANON ST.
Practice Address - Street 2:INTEGRATIVE WELLNESS, LLC
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052
Practice Address - Country:US
Practice Address - Phone:765-680-0071
Practice Address - Fax:765-680-0468
Is Sole Proprietor?:No
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99066384A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker