Healthcare Provider Details

I. General information

NPI: 1447668306
Provider Name (Legal Business Name): JENNA WILLFORD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S PRATT AVE
CARSON CITY NV
89701-4730
US

IV. Provider business mailing address

1404 ALDERSGATE CT
GARDNERVILLE NV
89410-5822
US

V. Phone/Fax

Practice location:
  • Phone: 775-882-3945
  • Fax:
Mailing address:
  • Phone: 530-545-9502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12197-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: