Provider Demographics
NPI:1407600869
Name:NATALIO, JENNY (SW23783)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:NATALIO
Suffix:
Gender:
Credentials:SW23783
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 TENNESSEE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-4208
Mailing Address - Country:US
Mailing Address - Phone:615-999-5730
Mailing Address - Fax:
Practice Address - Street 1:1701 TENNESSEE AVE STE 200
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-4208
Practice Address - Country:US
Practice Address - Phone:615-999-5730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-12
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW237831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical