Provider Demographics
NPI:1295820579
Name:YOUNG, JENNIFER L (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 CALHOUN ST, SUITE 200
Mailing Address - Street 2:UNIVERSITY OF CINCINNATI COUNSELING & PSYCHOLOGICAL SER
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219
Mailing Address - Country:US
Mailing Address - Phone:513-556-0648
Mailing Address - Fax:513-556-2302
Practice Address - Street 1:225 CALHOUN ST, SUITE 200
Practice Address - Street 2:UNIVERSITY OF CINCINNATI COUNSELING & PSYCHOLOGICAL SER
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219
Practice Address - Country:US
Practice Address - Phone:513-556-0648
Practice Address - Fax:513-556-2302
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2392-057103T00000X
OH6950103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39144900Medicaid