Provider Demographics
NPI:1497205306
Name:BRACCO, JENNA (LICENSED CLINICAL SO)
Entity Type:Individual
Prefix:MISS
First Name:JENNA
Middle Name:
Last Name:BRACCO
Suffix:
Gender:F
Credentials:LICENSED CLINICAL SO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1274 W. 7TH AVENUE SUITE 201
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402
Mailing Address - Country:US
Mailing Address - Phone:804-405-8452
Mailing Address - Fax:
Practice Address - Street 1:1274 W. 7TH AVENUE SUITE 201
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402
Practice Address - Country:US
Practice Address - Phone:804-405-8452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2019-03-26
Deactivation Date:2017-04-17
Deactivation Code:
Reactivation Date:2019-03-26
Provider Licenses
StateLicense IDTaxonomies
ORL70481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical