Healthcare Provider Details

I. General information

NPI: 1093693509
Provider Name (Legal Business Name): JENNIFER BOLDEN ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41593 WINCHESTER RD STE 150
TEMECULA CA
92590-4860
US

IV. Provider business mailing address

23750 MOUNT VERNON PL
MENIFEE CA
92587-9168
US

V. Phone/Fax

Practice location:
  • Phone: 951-775-3203
  • Fax:
Mailing address:
  • Phone: 760-450-7643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW130234
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: