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General NPI Number Information
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NPI Number | 1619009412
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Entity Type | Individual
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Provider Name | JENNIFER CAROL O'GEEN
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Gender | Female
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1414 SCENIC DR
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City | MODESTO
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State | CA
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Zip | 95355-4904
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Country | US
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Telephone | 209-550-5873
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Fax |
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Provider Business Mailing Address
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Address Line | 3180 N WALNUT RD APT 132
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City | TURLOCK
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State | CA
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Zip | 95382-9587
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS 23520
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License Number State | CA
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