Provider Demographics
NPI:1538272422
Name:HAMILTON, JENNIFER ALAINE (LCSW, CADC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ALAINE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 SPRING BANK DR
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-7553
Mailing Address - Country:US
Mailing Address - Phone:270-903-6332
Mailing Address - Fax:270-906-1150
Practice Address - Street 1:1401 SPRING BANK DR
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-7553
Practice Address - Country:US
Practice Address - Phone:270-903-6322
Practice Address - Fax:270-906-1150
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0946101YA0400X
KY31731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0026953Medicare PIN