Provider Demographics
NPI:1063718716
Name:STUMP, JENNIFER ANN (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ANN
Last Name:STUMP
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:MALONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW,LGSW
Mailing Address - Street 1:123 S LOUDOUN ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-4721
Mailing Address - Country:US
Mailing Address - Phone:240-979-8640
Mailing Address - Fax:
Practice Address - Street 1:123 S LOUDOUN ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4721
Practice Address - Country:US
Practice Address - Phone:540-431-5909
Practice Address - Fax:540-431-5366
Is Sole Proprietor?:No
Enumeration Date:2011-01-28
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500806091041C0700X
WVDP009437511041C0700X
VA09040089441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1063718716Medicaid