Provider Demographics
NPI:1992847909
Name:ALBRIGHT KNASH, JENNIFER GRACE (DAT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GRACE
Last Name:ALBRIGHT KNASH
Suffix:
Gender:F
Credentials:DAT
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:GRACE
Other - Last Name:ALBRIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DAT
Mailing Address - Street 1:3383 E LAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110-1437
Mailing Address - Country:US
Mailing Address - Phone:901-550-5338
Mailing Address - Fax:901-877-7991
Practice Address - Street 1:3383 E LAYTON AVE
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110-1437
Practice Address - Country:US
Practice Address - Phone:901-550-5338
Practice Address - Fax:901-877-7991
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5819-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100049329Medicaid