Provider Demographics
NPI:1992158836
Name:CELENTANO, JENNIFER LYNN (LISW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:CELENTANO
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:SPAULDING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1680 SW ANKENY RD STE 1A
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-8270
Mailing Address - Country:US
Mailing Address - Phone:515-489-4824
Mailing Address - Fax:515-206-8021
Practice Address - Street 1:1680 SW ANKENY RD STE 1A
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-8270
Practice Address - Country:US
Practice Address - Phone:515-489-4824
Practice Address - Fax:515-206-8021
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA081516101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health