Provider Demographics
NPI:1275280265
Name:WHITTEN, JENNIFER DANA (PCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DANA
Last Name:WHITTEN
Suffix:
Gender:F
Credentials:PCSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:DANA
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:517 W 100 N STE 210
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-9826
Mailing Address - Country:US
Mailing Address - Phone:435-755-6061
Mailing Address - Fax:435-994-8362
Practice Address - Street 1:2620 COMMERCIAL WAY STE 140
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-4750
Practice Address - Country:US
Practice Address - Phone:435-755-6061
Practice Address - Fax:435-994-8362
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPCSW-1010104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker