Provider Demographics
NPI:1801134572
Name:WORDEN, JENNIFER LYNN (MA, LLPC)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:LYNN
Last Name:WORDEN
Suffix:
Gender:F
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2126 SPRINGMONT AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-2701
Mailing Address - Country:US
Mailing Address - Phone:269-330-3523
Mailing Address - Fax:
Practice Address - Street 1:2126 SPRINGMONT AVE
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-2701
Practice Address - Country:US
Practice Address - Phone:269-330-3523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013242101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health