Provider Demographics
NPI:1689193963
Name:MCGOWAN, JENNIFER JOI
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JOI
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3029 W DOROTHY JEANNE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-8705
Mailing Address - Country:US
Mailing Address - Phone:708-915-0855
Mailing Address - Fax:
Practice Address - Street 1:2153 E JOYCE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5285
Practice Address - Country:US
Practice Address - Phone:479-575-9471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator