Provider Demographics
NPI:1477093409
Name:SYKEN, JENNA (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:SYKEN
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 DURFOR ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-4008
Mailing Address - Country:US
Mailing Address - Phone:302-377-9239
Mailing Address - Fax:
Practice Address - Street 1:500 16TH AVE
Practice Address - Street 2:
Practice Address - City:PROSPECT PARK
Practice Address - State:PA
Practice Address - Zip Code:19076-1120
Practice Address - Country:US
Practice Address - Phone:610-237-6410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART006054405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional