Provider Demographics
NPI:1568717684
Name:HODGE, JENNIFER NOWELLE (MA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:NOWELLE
Last Name:HODGE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 W 41ST PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90062-1520
Mailing Address - Country:US
Mailing Address - Phone:323-294-6311
Mailing Address - Fax:
Practice Address - Street 1:1860 W 41ST PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90062-1520
Practice Address - Country:US
Practice Address - Phone:323-294-6311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-14
Last Update Date:2012-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor