Provider Demographics
NPI:1649067232
Name:BAROLLI, JENNIFFER LYNN (LACT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFFER
Middle Name:LYNN
Last Name:BAROLLI
Suffix:
Gender:
Credentials:LACT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9132 W QUAIL AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-5343
Mailing Address - Country:US
Mailing Address - Phone:623-204-5023
Mailing Address - Fax:
Practice Address - Street 1:9132 W QUAIL AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-5343
Practice Address - Country:US
Practice Address - Phone:623-204-5023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15202101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)