Provider Demographics
NPI:1013433101
Name:MARTIN, JENNIFER LYNN (ED S)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:ED S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MOUNT CLINTON PIKE
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22802-2507
Mailing Address - Country:US
Mailing Address - Phone:540-564-3261
Mailing Address - Fax:540-564-3250
Practice Address - Street 1:100 MOUNT CLINTON PIKE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22802-2507
Practice Address - Country:US
Practice Address - Phone:540-564-3261
Practice Address - Fax:540-564-3261
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool