Provider Demographics
NPI:1467500769
Name:FERRAEZ, JENNIFER LYNN (MSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:FERRAEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 902
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-0039
Mailing Address - Country:US
Mailing Address - Phone:805-324-2658
Mailing Address - Fax:360-844-5184
Practice Address - Street 1:1450 BIRCH AVE
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-1417
Practice Address - Country:US
Practice Address - Phone:805-324-2658
Practice Address - Fax:360-844-5184
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL73851041C0700X
CALCS 257601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB251607Medicare Oscar/Certification