Provider Demographics
NPI:1528178126
Name:UNDERWOOD, JENNIE KATHLEEN (MS MFT)
Entity type:Individual
Prefix:MRS
First Name:JENNIE
Middle Name:KATHLEEN
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:MS MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 WESTWIND
Mailing Address - Street 2:STE 407
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301
Mailing Address - Country:US
Mailing Address - Phone:661-328-1233
Mailing Address - Fax:661-324-0485
Practice Address - Street 1:1800 WESTWIND
Practice Address - Street 2:STE 407
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301
Practice Address - Country:US
Practice Address - Phone:661-328-1233
Practice Address - Fax:661-324-0485
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31918106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist