Healthcare Provider Details

I. General information

NPI: 1427831213
Provider Name (Legal Business Name): JENIFER BREINER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 N HEMMER RD
PALMER AK
99645-9673
US

IV. Provider business mailing address

301 E DANNA AVE
WASILLA AK
99654-6422
US

V. Phone/Fax

Practice location:
  • Phone: 907-390-0542
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number254657
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: