Provider Demographics
NPI:1750837050
Name:BILLIARD, JENNIFER (MSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BILLIARD
Suffix:
Gender:F
Credentials:MSW
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 6423
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-6423
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11209 N TATUM BLVD
Practice Address - Street 2:#260
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-6025
Practice Address - Country:US
Practice Address - Phone:602-494-6800
Practice Address - Fax:602-494-6803
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical