Provider Demographics
NPI:1942690813
Name:CROKE, JENNIFER C (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:C
Last Name:CROKE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:CROKE
Other - Last Name:KUMPF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:5006 VARCO RD NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422-1806
Mailing Address - Country:US
Mailing Address - Phone:917-975-7712
Mailing Address - Fax:253-235-5236
Practice Address - Street 1:5120 VARCO RD NE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-1808
Practice Address - Country:US
Practice Address - Phone:917-975-7712
Practice Address - Fax:253-235-5236
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-30
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000096851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical