Provider Demographics
NPI:1639292246
Name:GEORGE MCGRAW, JENNIFER ANNE (MA ATR BC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANNE
Last Name:GEORGE MCGRAW
Suffix:
Gender:F
Credentials:MA ATR BC
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:ANNE
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:333 6TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:KY
Mailing Address - Zip Code:41074-1115
Mailing Address - Country:US
Mailing Address - Phone:859-581-6670
Mailing Address - Fax:
Practice Address - Street 1:519 LICKING PIKE
Practice Address - Street 2:
Practice Address - City:WILDER
Practice Address - State:KY
Practice Address - Zip Code:41071-2941
Practice Address - Country:US
Practice Address - Phone:859-572-0400
Practice Address - Fax:859-442-3363
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0144221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64283328Medicaid