Healthcare Provider Details

I. General information

NPI: 1619041738
Provider Name (Legal Business Name): ELIZABETH A JENNINGS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HEALTH CENTER DR
UNION WV
24983-8442
US

IV. Provider business mailing address

PO BOX 590
UNION WV
24983-0590
US

V. Phone/Fax

Practice location:
  • Phone: 304-327-5331
  • Fax: 304-327-5336
Mailing address:
  • Phone: 304-327-5331
  • Fax: 304-327-5336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number861
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: