Provider Demographics
NPI:1275182081
Name:ILGENFRITZ, JANE F (LCSW)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:F
Last Name:ILGENFRITZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 GRANITE ST
Mailing Address - Street 2:
Mailing Address - City:CORNWALL BORO
Mailing Address - State:PA
Mailing Address - Zip Code:17042-9248
Mailing Address - Country:US
Mailing Address - Phone:717-540-7278
Mailing Address - Fax:
Practice Address - Street 1:746 CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-5236
Practice Address - Country:US
Practice Address - Phone:717-540-7278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW013523101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty