Provider Demographics
NPI:1407287733
Name:BULLOCK, JENNIFER TESSIE
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:TESSIE
Last Name:BULLOCK
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 1:425 C ST NE
Mailing Address - Street 2:PEABODY ELEMENTARY/DC PUBLIC SCHOOLS (DCPS)
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-5817
Mailing Address - Country:US
Mailing Address - Phone:202-698-3277
Mailing Address - Fax:202-698-3275
Practice Address - Street 1:425 C ST NE
Practice Address - Street 2:PEABODY ELEMENTARY/DC PUBLIC SCHOOLS (DCPS)
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-5817
Practice Address - Country:US
Practice Address - Phone:202-698-3277
Practice Address - Fax:202-698-3275
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG102226104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker