Provider Demographics
NPI:1891523684
Name:KENNY, JESSICA DEANN (ASW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:DEANN
Last Name:KENNY
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12500 BRUCEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-9784
Mailing Address - Country:US
Mailing Address - Phone:916-874-1876
Mailing Address - Fax:
Practice Address - Street 1:12500 BRUCEVILLE RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-9784
Practice Address - Country:US
Practice Address - Phone:916-874-1876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1214811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical