Provider Demographics
NPI:1487125464
Name:JOHNSON, JENNIFER ELLEN
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ELLEN
Last Name:JOHNSON
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 1:614 HAVEN LN
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-2402
Mailing Address - Country:US
Mailing Address - Phone:831-578-9775
Mailing Address - Fax:
Practice Address - Street 1:614 HAVEN LN
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-2402
Practice Address - Country:US
Practice Address - Phone:831-578-9775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor