Provider Demographics
NPI:1588183859
Name:MINISCALCO, JENNA
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:MINISCALCO
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 1:107 E LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-2717
Mailing Address - Country:US
Mailing Address - Phone:717-733-8898
Mailing Address - Fax:
Practice Address - Street 1:107 E LOCUST ST
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-2717
Practice Address - Country:US
Practice Address - Phone:717-733-8898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty