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General NPI Number Information
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NPI Number | 1619041738
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Entity Type | Individual
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Provider Name | ELIZABETH A JENNINGS MA
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Gender | Female
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 200 HEALTH CENTER DR
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City | UNION
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State | WV
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Zip | 24983-8442
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Country | US
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Telephone | 304-327-5331
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Fax | 304-327-5336
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Provider Business Mailing Address
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Address Line | PO BOX 590
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City | UNION
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State | WV
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Zip | 24983-0590
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Country | US
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Telephone | 304-327-5331
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Fax | 304-327-5336
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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 | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 861
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License Number State | WV
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