MEDICARE: JENNIFER H. COLESEN 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	LCS 9785	CA

General Provider Information

NPI Number	:	1932374386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER H. COLESEN LCSW

Provider Business Mailing Address
First Line	:	9861 SPINNAKER DR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92646-6037
Country	:	US
Telephone Number	:	714-502-4833
Fax Number	:

Provider Business Practice Location Address
First Line	:	17610 BEACH BLVD STE 40
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-6845
Country	:	US
Telephone Number	:	714-502-4833
Fax Number	:

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

Provider Enumeration Date	:	04/28/2008
Last Update Date	:	04/28/2008

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