Provider Demographics
NPI:1124511936
Name:COOPER, JENNY LYNN (LMSW)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:LYNN
Last Name:COOPER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 E 4TH ST
Mailing Address - Street 2:STE 104
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-0001
Mailing Address - Country:US
Mailing Address - Phone:417-540-8527
Mailing Address - Fax:
Practice Address - Street 1:902 E 4TH ST
Practice Address - Street 2:STE 104
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-0001
Practice Address - Country:US
Practice Address - Phone:417-540-8527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20200236941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty