Healthcare Provider Details

I. General information

NPI: 1346416336
Provider Name (Legal Business Name): JENNIFER DOROTHEA ZWIREK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 E THOMAS RD
PHOENIX AZ
85014-5734
US

IV. Provider business mailing address

1201 E THOMAS RD
PHOENIX AZ
85014-5734
US

V. Phone/Fax

Practice location:
  • Phone: 602-285-0505
  • Fax: 602-285-1838
Mailing address:
  • Phone: 602-285-0505
  • Fax: 602-285-1838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW12125
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: