MEDICARE: MS. JENNIFER ANNE BUFFINGTON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	74477	CA

General Provider Information

NPI Number	:	1073825113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER ANNE BUFFINGTON LCSW

Provider Business Mailing Address
First Line	:	101 WIKIUP DR
Second Line	:	SUITE A
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-1375
Country	:	US
Telephone Number	:	707-545-2700
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 WIKIUP DR
Second Line	:	SUITE A
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-1375
Country	:	US
Telephone Number	:	707-545-2700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2010
Last Update Date	:	02/24/2017

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