Provider Demographics
NPI:1407035108
Name:BAGUE, JENNIFER IRENE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:IRENE
Last Name:BAGUE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 GOSHEN AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-8175
Mailing Address - Country:US
Mailing Address - Phone:559-324-5584
Mailing Address - Fax:559-324-5571
Practice Address - Street 1:2071 HERNDON AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-6101
Practice Address - Country:US
Practice Address - Phone:559-324-5584
Practice Address - Fax:559-324-5571
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA241191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical