Provider Demographics
NPI:1740401447
Name:HORNICK, JENNIFER LYNNE (BA, BSW, LSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNNE
Last Name:HORNICK
Suffix:
Gender:F
Credentials:BA, BSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24
Mailing Address - Street 2:
Mailing Address - City:BEECH BOTTOM
Mailing Address - State:WV
Mailing Address - Zip Code:26030-0024
Mailing Address - Country:US
Mailing Address - Phone:304-394-5466
Mailing Address - Fax:
Practice Address - Street 1:RR 1 BOX 256A
Practice Address - Street 2:
Practice Address - City:TRIADELPHIA
Practice Address - State:WV
Practice Address - Zip Code:26059-9725
Practice Address - Country:US
Practice Address - Phone:304-547-9197
Practice Address - Fax:304-547-9198
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAP00940521101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)