Provider Demographics
NPI:1528499589
Name:GREENOUGH, JENNYMARIE (LAC)
Entity type:Individual
Prefix:MS
First Name:JENNYMARIE
Middle Name:
Last Name:GREENOUGH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3044 RING RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-7932
Mailing Address - Country:US
Mailing Address - Phone:270-506-3853
Mailing Address - Fax:
Practice Address - Street 1:3044 RING RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7932
Practice Address - Country:US
Practice Address - Phone:270-506-3853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAC076171100000X
CAAC15873171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist