Provider Demographics
NPI:1194957670
Name:MANDIGO, JENNIFER (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:MANDIGO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:SCHENK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2190
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85132-3040
Mailing Address - Country:US
Mailing Address - Phone:520-866-5760
Mailing Address - Fax:
Practice Address - Street 1:971 NORTH JASON LOPEZ CIR
Practice Address - Street 2:BUILDING A
Practice Address - City:FLORENCE
Practice Address - State:AZ
Practice Address - Zip Code:85132-8513
Practice Address - Country:US
Practice Address - Phone:502-866-5770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60267748103TC0700X, 103TC0700X
AZPSY-005700103TC0700X
AZNA405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No405300000XOther Service ProvidersPrevention Professional