Healthcare Provider Details

I. General information

NPI: 1629314166
Provider Name (Legal Business Name): JENNIFER LEA KOS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2013
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

347 3RD ST # F1
BEAVER PA
15009-2356
US

IV. Provider business mailing address

347 3RD ST # F1
BEAVER PA
15009-2356
US

V. Phone/Fax

Practice location:
  • Phone: 330-398-4823
  • Fax: 855-938-3274
Mailing address:
  • Phone: 330-398-4823
  • Fax: 855-938-3274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC006662
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS020566
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP.07678
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: