Provider Demographics
NPI:1396042842
Name:PRENDERGAST, JENNIFER KAY (LCPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KAY
Last Name:PRENDERGAST
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 2ND AVE W
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4894
Mailing Address - Country:US
Mailing Address - Phone:406-755-4022
Mailing Address - Fax:406-755-4023
Practice Address - Street 1:322 2ND AVE W
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4894
Practice Address - Country:US
Practice Address - Phone:406-755-4022
Practice Address - Fax:406-755-4023
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1411101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health