Provider Demographics
NPI:1508280835
Name:PERRY, JENNIFER (LMSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1933 W ABERDEEN AVE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-5289
Mailing Address - Country:US
Mailing Address - Phone:208-250-1850
Mailing Address - Fax:
Practice Address - Street 1:5700 E FRANKLIN RD
Practice Address - Street 2:SUITE 220E
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-8497
Practice Address - Country:US
Practice Address - Phone:208-475-5710
Practice Address - Fax:208-475-5710
Is Sole Proprietor?:No
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW - 33558104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker