Provider Demographics
NPI:1114312220
Name:WOOD, JENNIFER VAN LUNTEREN
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:VAN LUNTEREN
Last Name:WOOD
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 1:401 E CHESTNUT ST UNIT 600
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-5705
Mailing Address - Country:US
Mailing Address - Phone:502-588-4425
Mailing Address - Fax:502-588-4427
Practice Address - Street 1:401 E CHESTNUT ST UNIT 610
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5711
Practice Address - Country:US
Practice Address - Phone:502-588-4450
Practice Address - Fax:502-588-9539
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY527612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry