Provider Demographics
NPI:1942814132
Name:GUTKE, JENNIFER (MC, LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GUTKE
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:
Other - First Name:JENI
Other - Middle Name:
Other - Last Name:GUTKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MC, LPC
Mailing Address - Street 1:21422 S 202ND ST
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-7445
Mailing Address - Country:US
Mailing Address - Phone:602-688-4154
Mailing Address - Fax:
Practice Address - Street 1:1176 E WARNER RD STE 211
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-3069
Practice Address - Country:US
Practice Address - Phone:602-688-4154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-22432101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health