Provider Demographics
NPI:1528781036
Name:VAZQUEZTELL, JENNIFER (MSW, PLCSW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:VAZQUEZTELL
Suffix:
Gender:F
Credentials:MSW, PLCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1666 WESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-6071
Mailing Address - Country:US
Mailing Address - Phone:307-214-3535
Mailing Address - Fax:
Practice Address - Street 1:265 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82072-3131
Practice Address - Country:US
Practice Address - Phone:307-214-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPCSW-10491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical