Provider Demographics
NPI:1295436350
Name:VEILLEUX, JENNIFER CELENE (PHD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CELENE
Last Name:VEILLEUX
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:CELENE
Other - Last Name:GLISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1650 N PORTER RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-1115
Mailing Address - Country:US
Mailing Address - Phone:479-339-9419
Mailing Address - Fax:
Practice Address - Street 1:1650 N PORTER RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-1115
Practice Address - Country:US
Practice Address - Phone:479-339-9419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2024-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR13-08P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical