Provider Demographics
NPI:1316134091
Name:TUTT, JENNIFER WHITNEY (LSCW 27530)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:WHITNEY
Last Name:TUTT
Suffix:
Gender:F
Credentials:LSCW 27530
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 WEST MARCH LN SUITE 125
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207
Mailing Address - Country:US
Mailing Address - Phone:209-465-1080
Mailing Address - Fax:
Practice Address - Street 1:2495 W MARCH LN
Practice Address - Street 2:SUITE 125
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-8251
Practice Address - Country:US
Practice Address - Phone:209-465-1080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22091ASW104100000X
CALCS 27530104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker