Provider Demographics
NPI:1598484958
Name:PARKER, JENNA LAUREN (LLMSW)
Entity Type:Individual
Prefix:MS
First Name:JENNA
Middle Name:LAUREN
Last Name:PARKER
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3298 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4725
Mailing Address - Country:US
Mailing Address - Phone:231-715-8466
Mailing Address - Fax:231-943-2263
Practice Address - Street 1:3298 VETERANS DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4725
Practice Address - Country:US
Practice Address - Phone:231-715-8466
Practice Address - Fax:231-943-2263
Is Sole Proprietor?:No
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851115338104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker