Healthcare Provider Details

I. General information

NPI: 1861692741
Provider Name (Legal Business Name): JENNIFER ANNE KEISER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER ANNE LAURSEN LLMSW

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18789 N REEMS RD STE 260
SURPRISE AZ
85374-8648
US

IV. Provider business mailing address

15411 W WADDELL RD STE 102 PMB#1193
SURPRISE AZ
85379-5170
US

V. Phone/Fax

Practice location:
  • Phone: 623-377-8397
  • Fax:
Mailing address:
  • Phone: 623-377-8397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-22513
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: