Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 0125 | KY |
NPI | 1992759526 |
---|---|
Provider Name | Suzanne Jardine-Lehman |
First Address | Covington, KY 41011-3717 |
Second Address | Fort Thomas, KY 41075-2421 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
184607 | MEDICARE GROUP NUMBER (01) | KY |