Provider Demographics
NPI:1851084701
Name:RICHARDSON, JENNA RACHELE
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:RACHELE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14476 OLD STATE ROAD 37
Mailing Address - Street 2:
Mailing Address - City:TELL CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47586-8620
Mailing Address - Country:US
Mailing Address - Phone:812-719-8509
Mailing Address - Fax:
Practice Address - Street 1:547 DAYTON ST
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3431
Practice Address - Country:US
Practice Address - Phone:888-884-4913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-29
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical