Provider Demographics
NPI:1013748417
Name:KIENTZ, JOANNA LENA
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:LENA
Last Name:KIENTZ
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 1:8401 STANSBURY ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-3737
Mailing Address - Country:US
Mailing Address - Phone:619-668-5880
Mailing Address - Fax:
Practice Address - Street 1:8401 STANSBURY ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-3737
Practice Address - Country:US
Practice Address - Phone:619-668-5880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1169131041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool