Provider Demographics
NPI:1083890552
Name:JENNINGS, ISA FELICITAS (MS)
Entity Type:Individual
Prefix:
First Name:ISA
Middle Name:FELICITAS
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 386
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:OR
Mailing Address - Zip Code:97437-0386
Mailing Address - Country:US
Mailing Address - Phone:541-914-0644
Mailing Address - Fax:
Practice Address - Street 1:24717 OAK LANE
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:OR
Practice Address - Zip Code:97437
Practice Address - Country:US
Practice Address - Phone:541-914-0644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health