Provider Demographics
NPI:1326403494
Name:IVORY, JENNIFER L (CBIS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:IVORY
Suffix:
Gender:F
Credentials:CBIS
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:CHARVET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:777 N CRUSEY STREET SUITE B101
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654
Mailing Address - Country:US
Mailing Address - Phone:907-746-3445
Mailing Address - Fax:907-746-3439
Practice Address - Street 1:777 N CRUSEY STREET SUITE B101
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-746-3445
Practice Address - Fax:907-746-3439
Is Sole Proprietor?:No
Enumeration Date:2015-12-16
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker