Provider Demographics
NPI:1376655720
Name:ELDRIDGE, JENNIFER JO (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JO
Last Name:ELDRIDGE
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 1:52 PINE CREEK RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9366
Mailing Address - Country:US
Mailing Address - Phone:724-719-7603
Mailing Address - Fax:
Practice Address - Street 1:52 PINE CREEK RD STE 200
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9366
Practice Address - Country:US
Practice Address - Phone:724-719-7603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015368103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232883955OtherTAX ID NUMBER
PA232883955OtherTAX ID NUMBER