Provider Demographics
NPI:1841347754
Name:ELY, JENNIFER ANN
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANN
Last Name:ELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4007 BROOKSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-9542
Mailing Address - Country:US
Mailing Address - Phone:724-327-1359
Mailing Address - Fax:
Practice Address - Street 1:331 SHAW AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:MCKEESPORT
Practice Address - State:PA
Practice Address - Zip Code:15132-2918
Practice Address - Country:US
Practice Address - Phone:412-678-4805
Practice Address - Fax:412-675-8912
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health