Provider Demographics
NPI:1164058558
Name:BANDLE, JENNIFER GENINE (BS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GENINE
Last Name:BANDLE
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 E GREEN ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18109-1825
Mailing Address - Country:US
Mailing Address - Phone:610-799-8910
Mailing Address - Fax:610-776-1694
Practice Address - Street 1:801 E GREEN ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18109-1825
Practice Address - Country:US
Practice Address - Phone:610-799-8910
Practice Address - Fax:610-776-1694
Is Sole Proprietor?:No
Enumeration Date:2020-03-17
Last Update Date:2020-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor