Provider Demographics
NPI:1265615561
Name:CHILDERS, JENNIFER PAULINE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:PAULINE
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 W 7TH PL
Mailing Address - Street 2:SUITE 7
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-1927
Mailing Address - Country:US
Mailing Address - Phone:405-269-4331
Mailing Address - Fax:405-533-2086
Practice Address - Street 1:2324 W 7TH PL
Practice Address - Street 2:SUITE 7
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-1927
Practice Address - Country:US
Practice Address - Phone:405-269-4331
Practice Address - Fax:405-533-2086
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK38381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical