Provider Demographics
NPI:1770876831
Name:WARREN, JENNIFER ELAINE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELAINE
Last Name:WARREN
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 1:1047 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:NM
Mailing Address - Zip Code:88435-2561
Mailing Address - Country:US
Mailing Address - Phone:575-472-5383
Mailing Address - Fax:575-472-5384
Practice Address - Street 1:1047 LAKE DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:NM
Practice Address - Zip Code:88435-2561
Practice Address - Country:US
Practice Address - Phone:575-472-5383
Practice Address - Fax:575-472-5384
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor