Provider Demographics
NPI:1760092951
Name:NUSS, JENNIFER CAROL (MA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CAROL
Last Name:NUSS
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 1:2447 APPLEBUTTER RD
Mailing Address - Street 2:
Mailing Address - City:HELLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18055-3302
Mailing Address - Country:US
Mailing Address - Phone:484-896-0493
Mailing Address - Fax:
Practice Address - Street 1:42 MAIN ST
Practice Address - Street 2:
Practice Address - City:HELLERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18055-1743
Practice Address - Country:US
Practice Address - Phone:484-896-0493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health