Provider Demographics
NPI:1659392439
Name:CLAUSON, JENNIFER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:CLAUSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1773
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-1773
Mailing Address - Country:US
Mailing Address - Phone:850-837-3800
Mailing Address - Fax:
Practice Address - Street 1:3997 COMMONS DR W
Practice Address - Street 2:STE C
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-8443
Practice Address - Country:US
Practice Address - Phone:850-837-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW14311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4393025OtherAETNA
FLZ5846OtherBCBS
FL4393025OtherAETNA