Healthcare Provider Details

I. General information

NPI: 1609732882
Provider Name (Legal Business Name): JACQUELINE JENNINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2025
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 E BROAD ST
BETHLEHEM PA
18018-6314
US

IV. Provider business mailing address

23 HAZE WAY
PHILLIPSBURG NJ
08865-7320
US

V. Phone/Fax

Practice location:
  • Phone: 484-861-4501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMF000118
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: