Provider Demographics
NPI:1992024657
Name:SMITH, JENNIFER STOLWORTHY
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:STOLWORTHY
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 PARALLEL DR. STE. B
Mailing Address - Street 2:COUNTY OF LAKE, MENTAL HEALTH
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453
Mailing Address - Country:US
Mailing Address - Phone:707-263-4338
Mailing Address - Fax:
Practice Address - Street 1:991 PARALLEL DR. STE. B
Practice Address - Street 2:COUNTY OF LAKE, MENTAL HEALTH
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453
Practice Address - Country:US
Practice Address - Phone:707-263-4338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator