Provider Demographics
NPI:1366006066
Name:ROUSH, JENNIFER DENISE
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DENISE
Last Name:ROUSH
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 1:110 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:WURTLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41144-1433
Mailing Address - Country:US
Mailing Address - Phone:606-922-7246
Mailing Address - Fax:
Practice Address - Street 1:1220 GREENUP AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7525
Practice Address - Country:US
Practice Address - Phone:606-393-1165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-28
Last Update Date:2019-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor