Provider Demographics
NPI:1821765702
Name:VASQUEZ, JENNIFER S (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:VASQUEZ
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 1:14789 PRAIRIE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-5620
Mailing Address - Country:US
Mailing Address - Phone:361-658-1193
Mailing Address - Fax:
Practice Address - Street 1:14789 PRAIRIE CREEK DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-5620
Practice Address - Country:US
Practice Address - Phone:361-549-5206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX395721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical