Provider Demographics
NPI:1376317263
Name:ANNAB, JENNIFER GENEVIEVE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GENEVIEVE
Last Name:ANNAB
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 1:1712 VALPAR DR
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-2344
Mailing Address - Country:US
Mailing Address - Phone:205-370-9233
Mailing Address - Fax:
Practice Address - Street 1:1712 VALPAR DR
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226-2344
Practice Address - Country:US
Practice Address - Phone:205-370-9233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA573362A103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool