Provider Demographics
NPI:1619637477
Name:WEATHERS, JENNA DARLENE (ACSW)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:DARLENE
Last Name:WEATHERS
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:DARLENE
Other - Last Name:WEATHERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACSW
Mailing Address - Street 1:638 ARCADIA DR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-3396
Mailing Address - Country:US
Mailing Address - Phone:707-689-4293
Mailing Address - Fax:
Practice Address - Street 1:638 ARCADIA DR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-3396
Practice Address - Country:US
Practice Address - Phone:707-689-4293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106430104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker