Provider Demographics
NPI:1528358819
Name:JEBITSCH, JENNA LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:LYNN
Last Name:JEBITSCH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 POND RD STE 75
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2280
Mailing Address - Country:US
Mailing Address - Phone:610-222-6436
Mailing Address - Fax:
Practice Address - Street 1:1620 POND RD STE 75
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-2280
Practice Address - Country:US
Practice Address - Phone:610-417-8198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-08
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC003794101YP2500X
PAPS017686103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional