Provider Demographics
NPI:1457689184
Name:CLEGG, JENNIFER L (LPC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:CLEGG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE MELLON WAY
Mailing Address - Street 2:BEHAVIORAL HEALTH
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650
Mailing Address - Country:US
Mailing Address - Phone:724-537-1662
Mailing Address - Fax:
Practice Address - Street 1:ONE MELLON WAY
Practice Address - Street 2:BEHAVIORAL HEALTH
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650
Practice Address - Country:US
Practice Address - Phone:724-537-1662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003654101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional