Provider Demographics
NPI:1437661048
Name:ZUCK, JENNIFER ALICE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ALICE
Last Name:ZUCK
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 MANSFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-2769
Mailing Address - Country:US
Mailing Address - Phone:215-538-9308
Mailing Address - Fax:
Practice Address - Street 1:314 W BROAD ST STE 108
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1287
Practice Address - Country:US
Practice Address - Phone:215-538-9308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-04
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC0075659101YP2500X
PAPC007569101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional