Provider Demographics
NPI:1912955535
Name:SCHAEFFER, JENNIFER J WILSON (PHD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J WILSON
Last Name:SCHAEFFER
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 1:280 PASADENA DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2925
Mailing Address - Country:US
Mailing Address - Phone:859-278-1316
Mailing Address - Fax:859-278-9896
Practice Address - Street 1:2416 REGENCY RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2954
Practice Address - Country:US
Practice Address - Phone:859-278-1316
Practice Address - Fax:859-278-9896
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1195103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1191578OtherCHA
000000195349OtherANTHEM
KY8900032700Medicaid
611142277QOtherHUMANA
680015706OtherRAILROAD MCR
KY8900032700Medicaid
KSS48909Medicare UPIN
000000195349OtherANTHEM