Provider Demographics
NPI:1841423688
Name:GREENUP, JENNIFER LYNN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:GREENUP
Suffix:
Gender:F
Credentials:LCSW
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 51364
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82605-1364
Mailing Address - Country:US
Mailing Address - Phone:307-247-3901
Mailing Address - Fax:
Practice Address - Street 1:330 S CENTER ST
Practice Address - Street 2:STE 305
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2875
Practice Address - Country:US
Practice Address - Phone:307-247-3901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW-6091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYLCSW-609OtherLCSW LICENSE