Provider Demographics
NPI:1750673802
Name:BRICKLIN, JENNIFER MARIE DALE (MS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE DALE
Last Name:BRICKLIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 LAKE OTIS PKWY
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5227
Mailing Address - Country:US
Mailing Address - Phone:805-234-0134
Mailing Address - Fax:
Practice Address - Street 1:4045 LAKE OTIS PKWY
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5227
Practice Address - Country:US
Practice Address - Phone:907-563-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-09
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT84555106H00000X
CA106H00000X
AK103954106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist