Provider Demographics
NPI:1407864317
Name:PERSCHKE, JENNY LEE (MSED, NCC, LPE)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:LEE
Last Name:PERSCHKE
Suffix:
Gender:F
Credentials:MSED, NCC, LPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 REIBER RD
Mailing Address - Street 2:
Mailing Address - City:RENFREW
Mailing Address - State:PA
Mailing Address - Zip Code:16053
Mailing Address - Country:US
Mailing Address - Phone:724-482-2489
Mailing Address - Fax:
Practice Address - Street 1:1607 THIRD STREET
Practice Address - Street 2:WESTERN PA PSYCH CARE
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009
Practice Address - Country:US
Practice Address - Phone:724-725-8411
Practice Address - Fax:724-728-8410
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003702101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
354367OtherMANAGED HEALTH NETWORD