Provider Demographics
NPI:1750698296
Name:AUDIA, JENNIFER PAIGE (MSW, ASW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PAIGE
Last Name:AUDIA
Suffix:
Gender:F
Credentials:MSW, ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2227 S EL CAMINO REAL
Mailing Address - Street 2:SUITE B
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6396
Mailing Address - Country:US
Mailing Address - Phone:760-757-1838
Mailing Address - Fax:760-757-6693
Practice Address - Street 1:5200 LANKERSHIM BLVD
Practice Address - Street 2:SUITE 170
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91601-3155
Practice Address - Country:US
Practice Address - Phone:818-980-3200
Practice Address - Fax:818-980-3203
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator