Provider Demographics
NPI:1336525443
Name:COCHRANE-NICOLLS, JENNIFER (MSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:COCHRANE-NICOLLS
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:PO BOX 1462
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98321-1462
Mailing Address - Country:US
Mailing Address - Phone:253-797-0391
Mailing Address - Fax:
Practice Address - Street 1:117 S. CEDAR ST.
Practice Address - Street 2:SUITE 2
Practice Address - City:BUCKLEY
Practice Address - State:WA
Practice Address - Zip Code:98321
Practice Address - Country:US
Practice Address - Phone:253-797-0391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC605880091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical