Healthcare Provider Details

I. General information

NPI: 1255988002
Provider Name (Legal Business Name): JENNIFER JACOBS RUDOLF MA, LPC, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 W GOVERNOR RD STE 200
HERSHEY PA
17033-2310
US

IV. Provider business mailing address

PO BOX 858 MC A410
HERSHEY PA
17033-0858
US

V. Phone/Fax

Practice location:
  • Phone: 717-531-7234
  • Fax: 717-531-0067
Mailing address:
  • Phone: 800-243-1455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC010079
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: