Provider Demographics
NPI:1710386636
Name:JENNINGS, KATHLEEN (MSW)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8711 PEBBLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PINCKNEY
Mailing Address - State:MI
Mailing Address - Zip Code:48169-8577
Mailing Address - Country:US
Mailing Address - Phone:734-878-5843
Mailing Address - Fax:
Practice Address - Street 1:8711 PEBBLE CREEK DR
Practice Address - Street 2:
Practice Address - City:PINCKNEY
Practice Address - State:MI
Practice Address - Zip Code:48169-8577
Practice Address - Country:US
Practice Address - Phone:734-878-5843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010638861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical