Provider Demographics
NPI:1952640922
Name:MCDONALD, JENNIFER L (MA, PPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:MA, PPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 14TH ST
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3745
Mailing Address - Country:US
Mailing Address - Phone:307-587-4215
Mailing Address - Fax:
Practice Address - Street 1:1001 14TH ST
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3745
Practice Address - Country:US
Practice Address - Phone:307-587-4215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-727101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional