Jennifer Nichole Phillips, LCSW
Individual provider Active NPI Clinical Social Worker · Jbsa-Lackland Afb, TX
NPI 1336804657 · NPPES record last updated May 30, 2023
Key facts
- NPI
- 1336804657
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 149.025204 (IL)
- Practice address
- 1100 Wilford Hall Loop
SGHC/Credentials
Jbsa-Lackland Afb, TX 78236 - Phone
- (210) 292-7749
- NPI assigned
- Nov 2, 2021
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MSW009491 | GA | MD | Social Worker |
| 149.025204 | IL | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | MSW009491 | GA | |
| Clinical Social Worker | 1041C0700X | 149.025204 | IL | Yes |
Addresses
Primary practice location
1100 Wilford Hall Loop
SGHC/Credentials
Jbsa-Lackland Afb, TX 78236
Mailing address
415 Fly Catcher
San Antonio, TX 78253-6973
Phone (850) 566-3077
Other practice location 1
2270 Stanley Rd Bldg 198
Jbsa Ft Sam Houston, TX 78234-2646
Phone (210) 221-1996
Other practice location 2
1061 Harmon Ave
Fort Stewart, GA 31314-5641
Phone (912) 435-7321
Other providers in Jbsa-Lackland Afb, TX
- Adam Mucci
- Joanna Marliss Funk Nelms
- Duy Quoc Nguyen
- Jon Jason O'Pry
- Tiffney Peters
- Marygayle Martin Radley
- Farhan Raza
All providers in Jbsa-Lackland Afb, TX · Clinical Social Worker in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 30, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.