Provider Demographics
NPI:1801029087
Name:RHODES, JENNIFER A (MSW,LSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:A
Last Name:RHODES
Suffix:
Gender:F
Credentials:MSW,LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 PEACH ORCHARD ROAD
Mailing Address - Street 2:
Mailing Address - City:MC CONNELLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17233
Mailing Address - Country:US
Mailing Address - Phone:717-485-6120
Mailing Address - Fax:717-485-6106
Practice Address - Street 1:214 PEACH ORCHARD ROAD
Practice Address - Street 2:
Practice Address - City:MC CONNELLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17233
Practice Address - Country:US
Practice Address - Phone:717-485-6120
Practice Address - Fax:717-485-6106
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
PASW127519101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023718600002Medicaid