Provider Demographics
NPI:1427099092
Name:MORGAN, JENNIFER (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:MORGAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11034 BANCROFT AVE NW
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-8686
Mailing Address - Country:US
Mailing Address - Phone:330-575-7096
Mailing Address - Fax:330-896-0887
Practice Address - Street 1:1790 TOWN PARK BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-7972
Practice Address - Country:US
Practice Address - Phone:330-575-7096
Practice Address - Fax:330-896-0887
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6142103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCP31231Medicare ID - Type Unspecified
OHMOCP31232Medicare PIN