Provider Demographics
NPI:1174962708
Name:WILLENBROCK, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WILLENBROCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 21ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-6149
Mailing Address - Country:US
Mailing Address - Phone:772-226-7818
Mailing Address - Fax:
Practice Address - Street 1:1910 82ND AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-6990
Practice Address - Country:US
Practice Address - Phone:772-492-9841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker