Healthcare Provider Details

I. General information

NPI: 1275659443
Provider Name (Legal Business Name): JENNIFER LUDROSKY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 04/08/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 ELM DR
WAYNESBURG PA
15370-8265
US

IV. Provider business mailing address

236 ELM DR SUITE 101
WAYNESBURG PA
15370-8265
US

V. Phone/Fax

Practice location:
  • Phone: 724-627-0926
  • Fax: 724-627-0812
Mailing address:
  • Phone: 304-852-4032
  • Fax: 304-627-0812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1111
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS016126
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: