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General NPI Number Information
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NPI Number | 1275659443
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Entity Type | Individual
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Provider Name | JENNIFER LUDROSKY PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 04/08/2022
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Provider Practice Location Address
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Address Line | 236 ELM DR
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City | WAYNESBURG
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State | PA
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Zip | 15370-8265
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Country | US
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Telephone | 724-627-0926
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Fax | 724-627-0812
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Provider Business Mailing Address
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Address Line | 236 ELM DR SUITE 101
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City | WAYNESBURG
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State | PA
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Zip | 15370-8265
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Country | US
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Telephone | 304-852-4032
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Fax | 304-627-0812
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1111
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS016126
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License Number State | PA
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