Provider Demographics
NPI:1942771217
Name:VANHOUTEN, JENNA SUE (BS, CT)
Entity Type:Individual
Prefix:MS
First Name:JENNA
Middle Name:SUE
Last Name:VANHOUTEN
Suffix:
Gender:F
Credentials:BS, CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 PRINCEWOOD AVE APT C
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5879
Mailing Address - Country:US
Mailing Address - Phone:937-267-6295
Mailing Address - Fax:
Practice Address - Street 1:3155 ELBEE RD STE 100
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-2046
Practice Address - Country:US
Practice Address - Phone:937-293-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1801392-TRNE101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor