Healthcare Provider Details

I. General information

NPI: 1316087638
Provider Name (Legal Business Name): JENNIFER ANN BATES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER ANN KING-BATES LCSW

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 11/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 W CLINTON AVE
FRESNO CA
93705-4201
US

IV. Provider business mailing address

841 E GRIFFITH WAY
FRESNO CA
93704-4220
US

V. Phone/Fax

Practice location:
  • Phone: 559-264-7521
  • Fax: 559-354-0166
Mailing address:
  • Phone: 209-585-6075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21971
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: