Provider Demographics
NPI:1114301512
Name:BICKNESE, JENNIFER LISA (MA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LISA
Last Name:BICKNESE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 E MIDDLE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-1946
Mailing Address - Country:US
Mailing Address - Phone:484-560-7439
Mailing Address - Fax:
Practice Address - Street 1:343 LINCOLN WAY W
Practice Address - Street 2:
Practice Address - City:NEW OXFORD
Practice Address - State:PA
Practice Address - Zip Code:17350-1003
Practice Address - Country:US
Practice Address - Phone:717-624-4461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010367101YP2500X
PA28 381 136221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist