Provider Demographics
NPI:1396885091
Name:LOTT, JENNIFER ANNE (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNE
Last Name:LOTT
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 1:1410 FAIRWOOD RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78722-1026
Mailing Address - Country:US
Mailing Address - Phone:512-695-8477
Mailing Address - Fax:
Practice Address - Street 1:4403 MANCHACA RD
Practice Address - Street 2:STE D
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1646
Practice Address - Country:US
Practice Address - Phone:512-695-8477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX505161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical