Provider Demographics
NPI:1245469659
Name:PACHECO, JENNIFER (LISW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PACHECO
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:SWINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:111 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52803-4609
Mailing Address - Country:US
Mailing Address - Phone:563-322-7419
Mailing Address - Fax:563-322-5339
Practice Address - Street 1:111 W 15TH ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52803-4609
Practice Address - Country:US
Practice Address - Phone:563-322-7419
Practice Address - Fax:563-322-5339
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker