Provider Demographics
NPI:1316398993
Name:EHRENBERG, JACQUELYN (MS, LAT, ATC, CES)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:
Last Name:EHRENBERG
Suffix:
Gender:F
Credentials:MS, LAT, ATC, CES
Other - Prefix:MS
Other - First Name:JACQUELYN
Other - Middle Name:
Other - Last Name:DANHIRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LAT, ATC, CES
Mailing Address - Street 1:472 SYLVANIA DR
Mailing Address - Street 2:
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-5333
Mailing Address - Country:US
Mailing Address - Phone:724-650-5048
Mailing Address - Fax:
Practice Address - Street 1:472 SYLVANIA DR
Practice Address - Street 2:
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-5333
Practice Address - Country:US
Practice Address - Phone:724-650-5048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-25
Last Update Date:2016-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARTO0001342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2000006014OtherNATIONAL ATHLETIC TRAINERS' BOARD OF CERTIFICATION, INC