Provider Demographics
NPI:1679879803
Name:BARTH, JENNIFER ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:BARTH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 E 17TH ST STE 5539
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-4543
Mailing Address - Country:US
Mailing Address - Phone:720-900-5272
Mailing Address - Fax:
Practice Address - Street 1:1920 THOMES AVE STE 500
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3547
Practice Address - Country:US
Practice Address - Phone:307-640-7720
Practice Address - Fax:307-464-3108
Is Sole Proprietor?:No
Enumeration Date:2011-02-05
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPY 3275103T00000X
FLPY 8062103TC0700X
WY658103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist