Provider Demographics
NPI:1619048246
Name:CURTIS, JENNIFER ANN (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:CURTIS
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:LILLICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:113 LINCOLNWAY E
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-2016
Mailing Address - Country:US
Mailing Address - Phone:574-255-4976
Mailing Address - Fax:
Practice Address - Street 1:221 RED COACH DR STE E
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-8324
Practice Address - Country:US
Practice Address - Phone:574-335-7630
Practice Address - Fax:574-335-0841
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005049A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300044931Medicaid
IN79521800OtherMAGELLAN
IN000000341298OtherANTHEM
IN000000530304OtherANTHEM BCBS
IN000000851241OtherBCBS BMG BEHAVIORAL HEALTH
IN000001342255OtherANTHEM