Provider Demographics
NPI:1376679589
Name:SMITH, JENNIFER DENISE
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DENISE
Last Name:SMITH
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 1:5009 CORRINE ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93304-7042
Mailing Address - Country:US
Mailing Address - Phone:661-835-9810
Mailing Address - Fax:
Practice Address - Street 1:2901 S H ST
Practice Address - Street 2:5009 CORRINE ST
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-5602
Practice Address - Country:US
Practice Address - Phone:661-398-4303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)