Provider Demographics
NPI:1407551229
Name:HAWELU, JENNIFER A (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:HAWELU
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 1:145 PEBBLE DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NV
Mailing Address - Zip Code:89403-9040
Mailing Address - Country:US
Mailing Address - Phone:925-914-9153
Mailing Address - Fax:
Practice Address - Street 1:401 DAYTON VALLEY RD STE B
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NV
Practice Address - Zip Code:89403-8921
Practice Address - Country:US
Practice Address - Phone:925-914-9153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9974-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical