Provider Demographics
NPI:1891369088
Name:SWINFORD, JENNIFER A (BA/CM)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:SWINFORD
Suffix:
Gender:F
Credentials:BA/CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4757 WV-152 SUITE 2
Mailing Address - Street 2:
Mailing Address - City:LAVALETTE
Mailing Address - State:WV
Mailing Address - Zip Code:25535
Mailing Address - Country:US
Mailing Address - Phone:304-522-1945
Mailing Address - Fax:
Practice Address - Street 1:4757 WV-152 SUITE 2
Practice Address - Street 2:
Practice Address - City:LAUALETTE
Practice Address - State:WV
Practice Address - Zip Code:25535
Practice Address - Country:US
Practice Address - Phone:304-522-1945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-13
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator