Provider Demographics
NPI:1134829591
Name:KING, JENNIFER (TLMHC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KING
Suffix:
Gender:
Credentials:TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5346 HEATHER GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-7538
Mailing Address - Country:US
Mailing Address - Phone:815-319-8382
Mailing Address - Fax:
Practice Address - Street 1:4624 PROGRESS DR UNIT 7
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3490
Practice Address - Country:US
Practice Address - Phone:563-279-0973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA117580101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty