Provider Demographics
NPI:1275659443
Name:LUDROSKY, JENNIFER (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:LUDROSKY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 ELM DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WAYNESBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15370-8265
Mailing Address - Country:US
Mailing Address - Phone:304-852-4032
Mailing Address - Fax:304-627-0812
Practice Address - Street 1:236 ELM DR
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:PA
Practice Address - Zip Code:15370-8265
Practice Address - Country:US
Practice Address - Phone:724-627-0926
Practice Address - Fax:724-627-0812
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1111103TC0700X
PAPS016126103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA584398OtherVALUE BEHAVIORAL HEALTH
1925061OtherBCBS
PA000000208894OtherUNISON KIDS
PA411613OtherUPMC
PA120523XP9Medicare PIN