Provider Demographics
NPI:1336013192
Name:GOWIN, JENELL
Entity type:Individual
Prefix:
First Name:JENELL
Middle Name:
Last Name:GOWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENELL
Other - Middle Name:
Other - Last Name:KNAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1112 IONE WAY
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95351-2147
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5815 STODDARD RD STE 600
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-9041
Practice Address - Country:US
Practice Address - Phone:209-348-9786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-03
Last Update Date:2025-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1073651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical