Provider Demographics
NPI:1871865170
Name:POLNIAK, JENNIFER LYNN (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:POLNIAK
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6956 STATE HIGHWAY 56
Mailing Address - Street 2:SUITE 1
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-3570
Mailing Address - Country:US
Mailing Address - Phone:315-268-0264
Mailing Address - Fax:315-268-0200
Practice Address - Street 1:6956 STATE HIGHWAY 56
Practice Address - Street 2:SUITE 1
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-3570
Practice Address - Country:US
Practice Address - Phone:315-268-0264
Practice Address - Fax:315-268-0200
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP75607101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health