Provider Demographics
NPI:1407600869
Name:NATALIO, JENNY (ISW17190)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:NATALIO
Suffix:
Gender:F
Credentials:ISW17190
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 W 15TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-1358
Mailing Address - Country:US
Mailing Address - Phone:850-257-5661
Mailing Address - Fax:
Practice Address - Street 1:2809 W 15TH ST STE 1
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-1358
Practice Address - Country:US
Practice Address - Phone:850-257-5661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW171901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical