Provider Demographics
NPI:1467038703
Name:BECK, JENNA MICHELLE (LSW)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:MICHELLE
Last Name:BECK
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 BENTEE WES CT
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-4037
Mailing Address - Country:US
Mailing Address - Phone:812-401-1836
Mailing Address - Fax:812-401-8013
Practice Address - Street 1:530 BENTEE WES CT
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-4037
Practice Address - Country:US
Practice Address - Phone:812-401-1836
Practice Address - Fax:812-401-8013
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34011162A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200238820Medicaid