Provider Demographics
NPI:1013405299
Name:KOESTERS, JENNA BETH (LPC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:BETH
Last Name:KOESTERS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 ARMSTRONG ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-1800
Mailing Address - Country:US
Mailing Address - Phone:419-394-7451
Mailing Address - Fax:419-394-8051
Practice Address - Street 1:720 ARMSTRONG ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-1800
Practice Address - Country:US
Practice Address - Phone:419-394-7451
Practice Address - Fax:419-394-8051
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
OHC.1901819101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0295403Medicaid