Provider Demographics
NPI:1225554942
Name:HODGES, JENNIFER ROSE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROSE
Last Name:HODGES
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 1:500 W WHITESTONE BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2271
Mailing Address - Country:US
Mailing Address - Phone:512-253-2561
Mailing Address - Fax:737-252-5011
Practice Address - Street 1:500 W WHITESTONE BLVD STE 105
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2271
Practice Address - Country:US
Practice Address - Phone:512-253-2561
Practice Address - Fax:737-252-5011
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1043051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR$$$$$$$$$Medicaid