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General NPI Number Information
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NPI Number | 1467500769
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Entity Type | Individual
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Provider Name | JENNIFER LYNN FERRAEZ MSW
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Gender | Female
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 04/27/2021
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Provider Practice Location Address
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Address Line | 1450 BIRCH AVE
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City | COTTAGE GROVE
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State | OR
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Zip | 97424-1417
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Country | US
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Telephone | 805-324-2658
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Fax | 360-844-5184
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Provider Business Mailing Address
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Address Line | PO BOX 902
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City | COTTAGE GROVE
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State | OR
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Zip | 97424-0039
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Country | US
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Telephone | 805-324-2658
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Fax | 360-844-5184
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | L7385
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS 25760
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License Number State | CA
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