Provider Demographics
NPI:1760888572
Name:DIAS, JENNA M (LMSW)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:M
Last Name:DIAS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:638 S BLUFF BLVD
Mailing Address - Street 2:BRIDGEVIEW COMMUNITY MENTAL HEALTH CENTER
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-4742
Mailing Address - Country:US
Mailing Address - Phone:563-243-5633
Mailing Address - Fax:563-243-9567
Practice Address - Street 1:638 S BLUFF BLVD
Practice Address - Street 2:BRIDGEVIEW COMMUNITY MENTAL HEALTH CENTER
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-4742
Practice Address - Country:US
Practice Address - Phone:563-243-5633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA008165104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
I17483Medicare PIN