Provider Demographics
NPI:1942469432
Name:FREELAND, JENNIFER T
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:T
Last Name:FREELAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1842
Mailing Address - Country:US
Mailing Address - Phone:814-453-7661
Mailing Address - Fax:814-455-1132
Practice Address - Street 1:136 EAST AVE
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1842
Practice Address - Country:US
Practice Address - Phone:814-453-7661
Practice Address - Fax:814-455-1132
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA07633593103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist