Provider Demographics
NPI:1285789701
Name:SUTHERLAND, JENNIFER KATHRYN (MS EDS)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:KATHRYN
Last Name:SUTHERLAND
Suffix:
Gender:F
Credentials:MS EDS
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:SUTHERLAND
Other - Last Name:HENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS EDS
Mailing Address - Street 1:2315 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356
Mailing Address - Country:US
Mailing Address - Phone:859-433-9526
Mailing Address - Fax:866-266-0695
Practice Address - Street 1:101 WIND HAVEN DR
Practice Address - Street 2:SUITE 202
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-8035
Practice Address - Country:US
Practice Address - Phone:859-277-0077
Practice Address - Fax:866-266-0695
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0054103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist