Provider Demographics
NPI:1093533580
Name:MOSLEY, JENNAH (LCSW)
Entity type:Individual
Prefix:
First Name:JENNAH
Middle Name:
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 SUGAR MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7703
Mailing Address - Country:US
Mailing Address - Phone:317-289-9144
Mailing Address - Fax:
Practice Address - Street 1:1108 SUGAR MAPLE DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-7703
Practice Address - Country:US
Practice Address - Phone:317-289-9144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34011149A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical