Provider Demographics
NPI:1497358808
Name:LEWIS, JENNIFER LYNN (MSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:GIBAULT CARE, INC.
Mailing Address - Street 2:6401 S. US HWY 41
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4749
Mailing Address - Country:US
Mailing Address - Phone:812-299-1156
Mailing Address - Fax:812-298-3109
Practice Address - Street 1:GIBAULT CARE, INC.
Practice Address - Street 2:6401 S. US HWY 41
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4749
Practice Address - Country:US
Practice Address - Phone:812-299-1156
Practice Address - Fax:812-298-3109
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker