Provider Demographics
NPI:1952099160
Name:RIEMENS-VAN LAARE, JENNIFER (ALC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:RIEMENS-VAN LAARE
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3429 CLIFF TER S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1528
Mailing Address - Country:US
Mailing Address - Phone:719-761-0057
Mailing Address - Fax:
Practice Address - Street 1:750 HIGHWAY 31 S
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-4627
Practice Address - Country:US
Practice Address - Phone:205-216-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04267101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health