Provider Demographics
NPI:1609247535
Name:ALLENSWORTH, JENNIFER (BA, CADC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ALLENSWORTH
Suffix:
Gender:F
Credentials:BA, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 S 2ND AVE W
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-3712
Mailing Address - Country:US
Mailing Address - Phone:641-792-0045
Mailing Address - Fax:641-787-0063
Practice Address - Street 1:303 S 2ND AVE W
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3712
Practice Address - Country:US
Practice Address - Phone:641-792-0045
Practice Address - Fax:641-787-0063
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA14035101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)