Provider Demographics
NPI:1689912370
Name:ZOLTOWSKI, JENNIFER M (MS, LLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:ZOLTOWSKI
Suffix:
Gender:F
Credentials:MS, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26711 WOODWARD AVE
Mailing Address - Street 2:SUITE LLA
Mailing Address - City:HUNTINGTON WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48070-1333
Mailing Address - Country:US
Mailing Address - Phone:248-677-0074
Mailing Address - Fax:
Practice Address - Street 1:26711 WOODWARD AVE
Practice Address - Street 2:SUITE LLA
Practice Address - City:HUNTINGTON WOODS
Practice Address - State:MI
Practice Address - Zip Code:48070-1333
Practice Address - Country:US
Practice Address - Phone:248-677-0074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-30
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011283103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical