Healthcare Provider Details

I. General information

NPI: 1760673016
Provider Name (Legal Business Name): JENNIFER SCHLIFE LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER SCHLIFE MSW

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 PROSPECT AVE NE STE C
ALBUQUERQUE NM
87110-4283
US

IV. Provider business mailing address

5005 PROSPECT AVE NE STE C
ALBUQUERQUE NM
87110-4283
US

V. Phone/Fax

Practice location:
  • Phone: 708-921-0683
  • Fax:
Mailing address:
  • Phone: 708-921-0683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149010334
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-06873
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: