Provider Demographics
NPI:1790079796
Name:BICKETT, JENIECE ELDER (CSW)
Entity Type:Individual
Prefix:
First Name:JENIECE
Middle Name:ELDER
Last Name:BICKETT
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1382 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-2351
Mailing Address - Country:US
Mailing Address - Phone:502-637-4361
Mailing Address - Fax:
Practice Address - Street 1:1382 S 3RD ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-2351
Practice Address - Country:US
Practice Address - Phone:502-637-4361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY47861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical