Provider Demographics
NPI:1235206814
Name:BOLTINGHOUSE, JENNIFER ANNETTE
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANNETTE
Last Name:BOLTINGHOUSE
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 1:17060 MONTEREY RD
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-3636
Mailing Address - Country:US
Mailing Address - Phone:408-540-9818
Mailing Address - Fax:
Practice Address - Street 1:17060 MONTEREY RD
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-3636
Practice Address - Country:US
Practice Address - Phone:408-540-9818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 101Y00000X
CA104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor