Provider Demographics
NPI:1245087832
Name:WATTS, JENNIFER WOODMAN
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WOODMAN
Last Name:WATTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 SOUTHAMPTON CIR
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2151
Mailing Address - Country:US
Mailing Address - Phone:205-337-3520
Mailing Address - Fax:
Practice Address - Street 1:2501 INTERNATIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-4253
Practice Address - Country:US
Practice Address - Phone:205-813-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4737101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health