Individual
JENNIFER L FLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
13321 W INDIAN SCHOOL RD, STE A107, LITCHFIELD PARK, AZ 85340-4339
(480) 565-3035
(480) 500-3902
Mailing address
13321 W INDIAN SCHOOL RD, STE A107, LITCHFIELD PARK, AZ 85340-4339
(602) 550-7844
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
LCSW-17212
AZ
1041C0700X
Clinical Social Worker
Primary
LCSW-17212
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
427136
—
AZ
Enumeration date
02/09/2017
Last updated
11/08/2018
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