Provider Demographics
NPI:1962018275
Name:GARNER-JEWETT, KATHLEEN I (LSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:I
Last Name:GARNER-JEWETT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:I
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3901 N PENNSYLVANIA ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-2653
Mailing Address - Country:US
Mailing Address - Phone:425-615-0779
Mailing Address - Fax:
Practice Address - Street 1:390 N MADISON AVE STE 201
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-2301
Practice Address - Country:US
Practice Address - Phone:317-296-5284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99100304A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker