Provider Demographics
NPI:1942919741
Name:INGRAM, JENNIFER (LCSW-BACS, C-SSWS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:INGRAM
Suffix:
Gender:F
Credentials:LCSW-BACS, C-SSWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 FOX RUN DR
Mailing Address - Street 2:
Mailing Address - City:NATCHITOCHES
Mailing Address - State:LA
Mailing Address - Zip Code:71457-7881
Mailing Address - Country:US
Mailing Address - Phone:318-663-5644
Mailing Address - Fax:
Practice Address - Street 1:115 FOX RUN DR
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-7881
Practice Address - Country:US
Practice Address - Phone:318-663-5644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA81351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical