Healthcare Provider Details

I. General information

NPI: 1447438411
Provider Name (Legal Business Name): JENNIFER JEAN JOHNCOX CAPSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER JEAN WEBER

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 N BROOKS ST
MADISON WI
53715-1002
US

IV. Provider business mailing address

109 BUCKINGHAM LN
MADISON WI
53714-2412
US

V. Phone/Fax

Practice location:
  • Phone: 608-280-7195
  • Fax:
Mailing address:
  • Phone: 608-245-9645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: