Provider Demographics
NPI:1871285817
Name:DEWEESE MENZEL, JENIFER
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:
Last Name:DEWEESE MENZEL
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 1:401 AUSTIN HWY STE 209
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-4670
Mailing Address - Country:US
Mailing Address - Phone:210-868-5103
Mailing Address - Fax:
Practice Address - Street 1:401 AUSTIN HWY STE 209
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-4670
Practice Address - Country:US
Practice Address - Phone:210-868-5103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79529101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional