Provider Demographics
NPI:1114665783
Name:CONN, JENNIFER K (LSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:CONN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 CLIFF RD
Mailing Address - Street 2:
Mailing Address - City:PENN WYNNE
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3530
Mailing Address - Country:US
Mailing Address - Phone:215-882-1270
Mailing Address - Fax:
Practice Address - Street 1:1509 CLIFF RD
Practice Address - Street 2:
Practice Address - City:PENN WYNNE
Practice Address - State:PA
Practice Address - Zip Code:19096-3530
Practice Address - Country:US
Practice Address - Phone:215-882-1270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1365071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical