Healthcare Provider Details

I. General information

NPI: 1881145134
Provider Name (Legal Business Name): JENNIFER JEPSON PSYD, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 09/06/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1224 E LOWELL ST
TUCSON AZ
85721-0400
US

IV. Provider business mailing address

1224 E LOWELL ST
TUCSON AZ
85721-0400
US

V. Phone/Fax

Practice location:
  • Phone: 907-227-9097
  • Fax:
Mailing address:
  • Phone: 907-227-9097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00006423
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number109915
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY-005186
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: