Provider Demographics
NPI:1548255821
Name:DAILEY, JENNIFER JEANNE (MSW LCSW ACSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEANNE
Last Name:DAILEY
Suffix:
Gender:F
Credentials:MSW LCSW ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4214 HOBSON CT
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-8648
Mailing Address - Country:US
Mailing Address - Phone:260-486-5251
Mailing Address - Fax:260-486-5058
Practice Address - Street 1:4214 HOBSON CT
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-8648
Practice Address - Country:US
Practice Address - Phone:260-486-5251
Practice Address - Fax:260-486-5058
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001306A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000293410OtherANTHEM
0007724640OtherAETNA US HEALTHCARE
337089OtherVALUEOPTIONS
36770OtherCIGNA
IN228230Medicare ID - Type Unspecified
36770OtherCIGNA