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General NPI Number Information
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NPI Number | 1134652662
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Entity Type | Individual
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Provider Name | JENNIFER AMANDA FRAGA MSW
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Gender | Female
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Dates
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Enumeration Date | 04/11/2017
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 13 S WILLSON AVE STE 9
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City | BOZEMAN
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State | MT
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Zip | 59715-4610
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Country | US
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Telephone | 917-716-7829
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Fax |
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Provider Business Mailing Address
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Address Line | 2272 NE KELLY ANN CT
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City | MCMINNVILLE
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State | OR
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Zip | 97128-8298
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L12224
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License Number State |
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