Provider Demographics
NPI:1336694603
Name:STROMMEN, JENNIFER (EDS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:STROMMEN
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3273 NATURES WALK
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2082
Mailing Address - Country:US
Mailing Address - Phone:305-812-2423
Mailing Address - Fax:
Practice Address - Street 1:3273 NATURES WALK
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2082
Practice Address - Country:US
Practice Address - Phone:305-812-2423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1074246103TS0200X
GA1217312103TS0200X
OK428513103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK428513OtherSCHOOL PSYCHOLOGIST
FL1074246OtherSCHOOL PSYCHOLOGIST
GA1217312OtherSCHOOL PSYCHOLOGIST