Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | 149013440 | IL |
N | 1041C0700X | Clinical Social Worker | 2446-C | AR |
Y | 1041C0700X | Clinical Social Worker | 5147 | TN |
NPI | 1003139635 |
---|---|
Provider Name | Mrs. Kenyetta D. Mcintosh-Jones |
First Address | Memphis, TN 38119-8304 |
Second Address | Memphis, TN 38104-2127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2010 |
Last Update Date | 10/03/2010 |