Provider Demographics
NPI:1992868640
Name:JENNINGS, ROBYN L (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ROBYN
Middle Name:L
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:ROBYN
Other - Middle Name:L
Other - Last Name:UHEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:303 W DANIELS AVE
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:63382-1015
Mailing Address - Country:US
Mailing Address - Phone:573-470-0478
Mailing Address - Fax:417-944-1440
Practice Address - Street 1:818 W CHAMP CLARK DR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:MO
Practice Address - Zip Code:63334-2034
Practice Address - Country:US
Practice Address - Phone:573-470-0478
Practice Address - Fax:417-944-1440
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005024322101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1992868640Medicaid