Provider Demographics
NPI:1063573517
Name:CUNNINGHAM, JENNIFER HANNON (LCSW-BACS)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:HANNON
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:LCSW-BACS
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:PAIGE
Other - Last Name:HANNON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-BACS
Mailing Address - Street 1:3843 HARDING BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70807-5224
Mailing Address - Country:US
Mailing Address - Phone:225-359-9315
Mailing Address - Fax:225-359-9326
Practice Address - Street 1:3843 HARDING BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70807-5224
Practice Address - Country:US
Practice Address - Phone:225-359-9315
Practice Address - Fax:225-359-9326
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA42651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical