Provider Demographics
NPI:1164294237
Name:WOLBERT, JENNA LEEANN (LSW)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LEEANN
Last Name:WOLBERT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:LEEANN
Other - Last Name:CAULFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1134 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-1223
Mailing Address - Country:US
Mailing Address - Phone:814-346-1312
Mailing Address - Fax:814-346-1312
Practice Address - Street 1:1134 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-1223
Practice Address - Country:US
Practice Address - Phone:814-346-1312
Practice Address - Fax:814-346-1312
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW140330104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker