Provider Demographics
NPI:1962694158
Name:JENNINGS, TAWANDA WILSON
Entity type:Individual
Prefix:MRS
First Name:TAWANDA
Middle Name:WILSON
Last Name:JENNINGS
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 1:1816 CHESSLAND ST
Mailing Address - Street 2:APT. 5
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15205-4035
Mailing Address - Country:US
Mailing Address - Phone:412-937-4685
Mailing Address - Fax:
Practice Address - Street 1:1816 CHESSLAND ST
Practice Address - Street 2:APT. 5
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-4035
Practice Address - Country:US
Practice Address - Phone:412-937-4685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health