Provider Demographics
NPI:1366513665
Name:LENNEMAN, JESSICA LEE PIERZINA (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:LEE PIERZINA
Last Name:LENNEMAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MISS
Other - First Name:JESSICA
Other - Middle Name:LEE
Other - Last Name:PIERZINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:251 EDELWEISS DR
Mailing Address - Street 2:STE 1B
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-3933
Mailing Address - Country:US
Mailing Address - Phone:408-482-2539
Mailing Address - Fax:
Practice Address - Street 1:251 EDELWEISS DR
Practice Address - Street 2:STE 1B
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-3933
Practice Address - Country:US
Practice Address - Phone:408-482-2539
Practice Address - Fax:406-794-0367
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 187831041C0700X
CALCS 25856101YM0800X
MTSWP-LCSW LIC-8029101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTM011006526OtherPTAN