Basic Information
| Provider Information | |||||||||
| NPI: | 1679927388 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BADDORF | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MCGARITY | ||||||||
| OtherFirstName: | JESSICA | ||||||||
| OtherMiddleName: | LYNN | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 9407 EXECUTIVE PARK DRIVE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8652294728 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9047 EXECUTIVE PARK DR STE 210 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379234625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659831899 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2016 | ||||||||
| LastUpdateDate: | 10/07/2019 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | LSW11575 | TN | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 7140 | TN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | 095721 | NY | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.