Provider Demographics
NPI:1679613285
Name:PAHL, JENNIFER DORY (LCSW)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:DORY
Last Name:PAHL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2497
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-2497
Mailing Address - Country:US
Mailing Address - Phone:775-884-0707
Mailing Address - Fax:775-884-2569
Practice Address - Street 1:309 E JOHN ST STE 1
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-3071
Practice Address - Country:US
Practice Address - Phone:775-884-0707
Practice Address - Fax:775-884-2569
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4871-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical