1366513665 NPI number — MS. JESSICA LEE PIERZINA LENNEMAN MSW, LCSW

Table of content: MS. JESSICA LEE PIERZINA LENNEMAN MSW, LCSW (NPI 1366513665)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366513665 NPI number — MS. JESSICA LEE PIERZINA LENNEMAN MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LENNEMAN
Provider First Name:
JESSICA
Provider Middle Name:
LEE PIERZINA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PIERZINA
Provider Other First Name:
JESSICA
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366513665
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
251 EDELWEISS DR
Provider Second Line Business Mailing Address:
STE 1B
Provider Business Mailing Address City Name:
BOZEMAN
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59718-3933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-482-2539
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
251 EDELWEISS DR
Provider Second Line Business Practice Location Address:
STE 1B
Provider Business Practice Location Address City Name:
BOZEMAN
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59718-3933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-482-2539
Provider Business Practice Location Address Fax Number:
406-794-0367
Provider Enumeration Date:
11/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  ASW 18783 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: LCS 25856 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: SWP-LCSW LIC-8029 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: M011006526 . This is a "PTAN" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".