Provider Demographics
NPI:1265102883
Name:TESTER, JENNY MARIE
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:MARIE
Last Name:TESTER
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 1:926 W OAKLAND AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-1445
Mailing Address - Country:US
Mailing Address - Phone:423-282-3379
Mailing Address - Fax:
Practice Address - Street 1:926 W OAKLAND AVE STE 206
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-1445
Practice Address - Country:US
Practice Address - Phone:423-282-3379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker