Provider Demographics
NPI:1902833098
Name:FRANK, JENNIFER L (PHD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:FRANK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:LEACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 1530
Mailing Address - Street 2:
Mailing Address - City:HAVRE
Mailing Address - State:MT
Mailing Address - Zip Code:59501-1530
Mailing Address - Country:US
Mailing Address - Phone:406-265-5827
Mailing Address - Fax:406-265-5949
Practice Address - Street 1:409 14TH ST SW
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-2721
Practice Address - Country:US
Practice Address - Phone:406-265-3201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1241101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1241OtherLICENSE NUMBER