Provider Demographics
NPI:1164692794
Name:COLLIER, JENNIFER WOOD (LSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WOOD
Last Name:COLLIER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:COLLIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSW
Mailing Address - Street 1:335 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LEHIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:18235-1464
Mailing Address - Country:US
Mailing Address - Phone:610-377-8525
Mailing Address - Fax:
Practice Address - Street 1:564 MAIN ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-2004
Practice Address - Country:US
Practice Address - Phone:570-420-3202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW124301101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health