Individual
JENNIFER NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
215 COWBOY WAY, EDGEWOOD, NM 87015-9616
(505) 464-7213
Mailing address
PO BOX 1080, ESTANCIA, NM 87016-1080
(505) 750-0105
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C-12014
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33014042
—
NM
Enumeration date
11/19/2018
Last updated
07/21/2024
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