Provider Demographics
NPI:1902207533
Name:PACKER, JENNIFER P (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:P
Last Name:PACKER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7628 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:AL
Mailing Address - Zip Code:35094-7216
Mailing Address - Country:US
Mailing Address - Phone:205-586-5644
Mailing Address - Fax:
Practice Address - Street 1:1820 3RD AVE N
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35020
Practice Address - Country:US
Practice Address - Phone:205-586-5644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical