MEDICARE: MS. JENNIFER LORRAINE KOLLEN BA, MSW

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	101Y00000X	Counselor
2	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1114113321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER LORRAINE KOLLEN BA, MSW

Provider Business Mailing Address
First Line	:	1201 SHAFFER RD STE 1A
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-5761
Country	:	US
Telephone Number	:	831-247-6510
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 SHAFFER RD STE 1A
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-5761
Country	:	US
Telephone Number	:	831-247-6510
Fax Number	:

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

Provider Enumeration Date	:	09/20/2007
Last Update Date	:	08/24/2023

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