Provider Demographics
NPI:1962471219
Name:MCCOOL, JENNIFER ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:MCCOOL
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 1:4411 WASHINGTON AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0900
Mailing Address - Country:US
Mailing Address - Phone:812-479-1916
Mailing Address - Fax:812-479-5014
Practice Address - Street 1:4411 WASHINGTON AVE STE 300
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0900
Practice Address - Country:US
Practice Address - Phone:812-479-1916
Practice Address - Fax:812-479-5014
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003926A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200238820Medicaid
IN188620Medicare ID - Type Unspecified