Provider Demographics
NPI:1205120292
Name:MORRIS, JENNIFER DAWN (HS-BCP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DAWN
Last Name:MORRIS
Suffix:
Gender:F
Credentials:HS-BCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 MAJOR AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-2342
Mailing Address - Country:US
Mailing Address - Phone:307-856-6587
Mailing Address - Fax:307-856-2668
Practice Address - Street 1:4016 SPY GLASS CIR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-5433
Practice Address - Country:US
Practice Address - Phone:307-857-5484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1003812694Medicaid