Provider Demographics
NPI:1619041738
Name:JENNINGS, ELIZABETH A (MA)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:A
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 JEFFERSON ST
Mailing Address - Street 2:PO BOX902
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-4013
Mailing Address - Country:US
Mailing Address - Phone:304-327-5331
Mailing Address - Fax:304-327-5336
Practice Address - Street 1:1705 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:WV
Practice Address - Zip Code:24701-4013
Practice Address - Country:US
Practice Address - Phone:304-327-5331
Practice Address - Fax:304-327-5336
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV861103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent