Provider Demographics
NPI:1205159647
Name:JENNINGS, JENNIFER (MS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-2504
Mailing Address - Country:US
Mailing Address - Phone:662-323-9261
Mailing Address - Fax:662-324-9647
Practice Address - Street 1:302 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2504
Practice Address - Country:US
Practice Address - Phone:662-323-9261
Practice Address - Fax:662-324-9647
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health