Provider Demographics
NPI:1205257292
Name:BRAND, JENNIFER ANN (MSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:BRAND
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-4101
Mailing Address - Country:US
Mailing Address - Phone:502-223-2182
Mailing Address - Fax:502-223-3338
Practice Address - Street 1:191 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4101
Practice Address - Country:US
Practice Address - Phone:502-223-2182
Practice Address - Fax:502-223-3338
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid