Provider Demographics
NPI:1134250129
Name:BOURDAGE, JERELYN F (MSW)
Entity type:Individual
Prefix:MRS
First Name:JERELYN
Middle Name:F
Last Name:BOURDAGE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 VAN HOUTEN AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-4429
Mailing Address - Country:US
Mailing Address - Phone:619-401-3800
Mailing Address - Fax:
Practice Address - Street 1:151 VAN HOUTEN AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4429
Practice Address - Country:US
Practice Address - Phone:619-401-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker