MEDICARE: JENNIFER MARIE WEATHERFORD LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	000341	IA

General Provider Information

NPI Number	:	1194095018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MARIE WEATHERFORD LMFT

Provider Business Mailing Address
First Line	:	595 ASHLEY CT STE 7
Second Line	:
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317-4758
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	595 ASHLEY CT STE 7
Second Line	:
City	:	NORTH LIBERTY
State	:	IA
Zip	:	52317-4758
Country	:	US
Telephone Number	:	319-343-7650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2012
Last Update Date	:	11/21/2025

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