Provider Demographics
NPI:1235906975
Name:POCHUE, JENNIFER ANGELA
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANGELA
Last Name:POCHUE
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 1:6562 CALIENTE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:OAK HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92344-0745
Mailing Address - Country:US
Mailing Address - Phone:760-490-0109
Mailing Address - Fax:760-780-1561
Practice Address - Street 1:14420 CIVIC DR STE 4
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-2384
Practice Address - Country:US
Practice Address - Phone:760-490-0109
Practice Address - Fax:760-780-1561
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1099771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical