Healthcare Provider Details

I. General information

NPI: 1578996963
Provider Name (Legal Business Name): JENNIFER L PAYTON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER L ROLLINS LCSW

II. Dates (important events)

Enumeration Date: 08/20/2013
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 S CHECK ST SUITE 101
WASILLA AK
99654-8067
US

IV. Provider business mailing address

7362 W PARKS HWY #647
WASILLA AK
99623-9300
US

V. Phone/Fax

Practice location:
  • Phone: 907-357-4673
  • Fax: 907-357-1639
Mailing address:
  • Phone: 907-357-4673
  • Fax: 907-357-1639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number468
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: