Healthcare Provider Details

I. General information

NPI: 1023141843
Provider Name (Legal Business Name): JENNIFER CHRISTINE BLACKWELL ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 N VILLA AVE
WILLOWS CA
95988-2641
US

IV. Provider business mailing address

242 N VILLA AVE
WILLOWS CA
95988-2641
US

V. Phone/Fax

Practice location:
  • Phone: 530-934-6582
  • Fax: 530-934-6592
Mailing address:
  • Phone: 530-934-6582
  • Fax: 530-934-6592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW 20837
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: