Healthcare Provider Details

I. General information

NPI: 1447286927
Provider Name (Legal Business Name): JENNIFER J. HIBBS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 N CENTRAL AVE STE. #416
MEDFORD OR
97501-5900
US

IV. Provider business mailing address

33 N CENTRAL AVE STE. #416
MEDFORD OR
97501-5900
US

V. Phone/Fax

Practice location:
  • Phone: 541-773-3460
  • Fax: 541-500-8160
Mailing address:
  • Phone: 541-773-3460
  • Fax: 541-500-8160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1324
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: