Provider Demographics
NPI:1386369973
Name:WEBB, JENNIFER (PLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WEBB
Suffix:
Gender:F
Credentials:PLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10352 E JAROD JAMES PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-2807
Mailing Address - Country:US
Mailing Address - Phone:206-370-0299
Mailing Address - Fax:
Practice Address - Street 1:1701 N CENTAL
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-6570
Practice Address - Country:US
Practice Address - Phone:417-476-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022038814103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical