Provider Demographics
NPI:1508541418
Name:JEFFRIES, JADA (ASW)
Entity Type:Individual
Prefix:
First Name:JADA
Middle Name:
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 ORCHARD ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-3737
Mailing Address - Country:US
Mailing Address - Phone:707-478-3837
Mailing Address - Fax:
Practice Address - Street 1:3434 MENDOCINO AVE # A
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2274
Practice Address - Country:US
Practice Address - Phone:707-284-1978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109768104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker