Provider Demographics
NPI:1194869230
Name:MCMINN, JENNIFER LYNN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:MCMINN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2950 BRECKENRIDGE LN
Mailing Address - Street 2:10 A
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1462
Mailing Address - Country:US
Mailing Address - Phone:502-314-0100
Mailing Address - Fax:502-454-7507
Practice Address - Street 1:2950 BRECKENRIDGE LN
Practice Address - Street 2:10 A
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1462
Practice Address - Country:US
Practice Address - Phone:502-314-0100
Practice Address - Fax:502-454-7507
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical