Provider Demographics
NPI:1043451925
Name:HAYWOOD, JENNIFER L
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:HAYWOOD
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 1:3203 BRICK CHURCH PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-2800
Mailing Address - Country:US
Mailing Address - Phone:615-262-7822
Mailing Address - Fax:615-262-7823
Practice Address - Street 1:3203 BRICK CHURCH PIKE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37207-2800
Practice Address - Country:US
Practice Address - Phone:615-262-7822
Practice Address - Fax:615-262-7823
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
TN2946101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional