Provider Demographics
NPI:1053954735
Name:MARSDEN, JENNY LARA
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:LARA
Last Name:MARSDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 CAMPBELL DR
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-3403
Mailing Address - Country:US
Mailing Address - Phone:307-575-5841
Mailing Address - Fax:
Practice Address - Street 1:806 CAMPBELL DR
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-3403
Practice Address - Country:US
Practice Address - Phone:307-575-5841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health