Provider Demographics
NPI:1629314166
Name:KOS, JENNIFER LEA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEA
Last Name:KOS
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 1:8577 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2345
Mailing Address - Country:US
Mailing Address - Phone:330-856-6663
Mailing Address - Fax:
Practice Address - Street 1:250 INSURANCE ST STE 202
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2760
Practice Address - Country:US
Practice Address - Phone:330-398-4823
Practice Address - Fax:855-938-3274
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.07678103TC0700X
PAPC006662101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical