Provider Demographics
NPI:1851747927
Name:MCCLASKEY JEROME, JENNIFER ANN (MAED/ES, BSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:MCCLASKEY JEROME
Suffix:
Gender:F
Credentials:MAED/ES, BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3320 WALL BLVD APT 12-301
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7779
Mailing Address - Country:US
Mailing Address - Phone:562-676-6988
Mailing Address - Fax:
Practice Address - Street 1:1141 WHITNEY AVE
Practice Address - Street 2:BUILDING 4
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-5011
Practice Address - Country:US
Practice Address - Phone:972-391-4084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)