Provider Demographics
NPI:1891256160
Name:JENNINGS, CHEREESE LUPEANN (MS)
Entity Type:Individual
Prefix:
First Name:CHEREESE
Middle Name:LUPEANN
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:CHEREESE
Other - Middle Name:LUPEANN
Other - Last Name:CARRRILLO- EGGLESTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1364 CORVALLIS HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:MT
Mailing Address - Zip Code:59828-9550
Mailing Address - Country:US
Mailing Address - Phone:442-279-8696
Mailing Address - Fax:
Practice Address - Street 1:1364 CORVALLIS HILLS DR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:MT
Practice Address - Zip Code:59828-9550
Practice Address - Country:US
Practice Address - Phone:442-279-8696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT702851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical