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General NPI Number Information
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NPI Number | 1114708658
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Entity Type | Individual
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Provider Name | JENNIFER LYNNE KISSNER
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Gender | Female
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Dates
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Enumeration Date | 10/10/2023
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Last Update Date | 10/17/2023
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Provider Practice Location Address
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Address Line | 7530 E MAIN ST APT 201
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-4574
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Country | US
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Telephone | 480-800-9303
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Fax |
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Provider Business Mailing Address
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Address Line | 834 E WHITTEN ST
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City | CHANDLER
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State | AZ
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Zip | 85225-6444
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Country | US
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Telephone | 701-721-0474
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LAC-20440
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License Number State | AZ
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