Provider Demographics
NPI:1366636409
Name:WILLEM, JENNIFER DASSO (MSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DASSO
Last Name:WILLEM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5645 ENCHANTING OAKS DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8586
Mailing Address - Country:US
Mailing Address - Phone:850-477-6428
Mailing Address - Fax:
Practice Address - Street 1:5645 ENCHANTING OAKS DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8586
Practice Address - Country:US
Practice Address - Phone:850-477-6428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker