Provider Demographics
NPI:1285211102
Name:SEIFERT, JENNA NICOLE
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:NICOLE
Last Name:SEIFERT
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 1:1414 ARROWHEAD DR N
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12302-3528
Mailing Address - Country:US
Mailing Address - Phone:518-860-2397
Mailing Address - Fax:
Practice Address - Street 1:288 GALLISON HILL RD
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-8947
Practice Address - Country:US
Practice Address - Phone:802-559-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT146.0134206103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst