Provider Demographics
NPI:1790907731
Name:DAY, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4165 WESTPORT RD STE 303
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2786
Mailing Address - Country:US
Mailing Address - Phone:502-509-3082
Mailing Address - Fax:
Practice Address - Street 1:4165 WESTPORT RD STE 303
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2786
Practice Address - Country:US
Practice Address - Phone:502-759-2517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY130797103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30605018Medicaid
KY000000539132OtherANTHEM
KY0762349Medicare PIN
KY0690953Medicare PIN
KY00205007Medicare PIN
KY00206007Medicare PIN
KY00201009Medicare PIN
KY0763549Medicare PIN
KY0974722Medicare PIN
KY000000539132OtherANTHEM
KY00207007Medicare PIN
KY00200009Medicare PIN
KY00199009Medicare PIN