MEDICARE: JENNIFER DARLYNN WILLSEY

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1376472233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER DARLYNN WILLSEY

Provider Business Mailing Address
First Line	:	2489 K ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92102-2963
Country	:	US
Telephone Number	:	619-278-1828
Fax Number	:

Provider Business Practice Location Address
First Line	:	2410 E ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92102-2024
Country	:	US
Telephone Number	:	619-234-3346
Fax Number	:

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

Provider Enumeration Date	:	05/18/2026
Last Update Date	:	05/18/2026

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