Provider Demographics
NPI:1386957538
Name:OLIVA, JENNIFER R (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:OLIVA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JEN
Other - Middle Name:
Other - Last Name:OLIVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:I
Mailing Address - Street 1:PO BOX 1133
Mailing Address - Street 2:
Mailing Address - City:ANACONDA
Mailing Address - State:MT
Mailing Address - Zip Code:59711-1133
Mailing Address - Country:US
Mailing Address - Phone:406-691-0326
Mailing Address - Fax:
Practice Address - Street 1:118 E 7TH ST
Practice Address - Street 2:
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-2900
Practice Address - Country:US
Practice Address - Phone:406-691-0326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical