Provider Demographics
NPI:1245970003
Name:KOERNER, JAYLYNNE ELIZABETH (LCSWA)
Entity type:Individual
Prefix:
First Name:JAYLYNNE
Middle Name:ELIZABETH
Last Name:KOERNER
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5300
Mailing Address - Country:US
Mailing Address - Phone:910-493-3555
Mailing Address - Fax:910-493-3520
Practice Address - Street 1:920 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5300
Practice Address - Country:US
Practice Address - Phone:910-493-3555
Practice Address - Fax:910-493-3520
Is Sole Proprietor?:No
Enumeration Date:2022-03-30
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 171M00000X
NCP0207451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator