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General NPI Number Information
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NPI Number | 1366744385
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Entity Type | Individual
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Provider Name | JENNIFER L. CULLOP B.A.
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Gender | Female
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Dates
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Enumeration Date | 11/23/2010
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Last Update Date | 11/23/2010
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Provider Practice Location Address
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Address Line | 15621 N 173RD LN
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City | SURPRISE
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State | AZ
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Zip | 85388-1224
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Country | US
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Telephone | 623-875-6067
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Fax |
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Provider Business Mailing Address
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Address Line | 5501 N 19TH AVE SUITE 310
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City | PHOENIX
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State | AZ
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Zip | 85015-2450
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Country | US
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Telephone | 602-433-1344
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Fax | 602-249-1570
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 8043
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License Number State | AZ
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