Provider Demographics
NPI:1619775640
Name:JENNIFER SHANKS, LCSW, LCADC
Entity type:Organization
Organization Name:JENNIFER SHANKS, LCSW, LCADC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCADC
Authorized Official - Phone:502-548-5647
Mailing Address - Street 1:907 BROADFIELDS DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4341
Mailing Address - Country:US
Mailing Address - Phone:502-548-5647
Mailing Address - Fax:
Practice Address - Street 1:161 SAINT MATTHEWS AVE STE 18
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3145
Practice Address - Country:US
Practice Address - Phone:502-548-5647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-05
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty