MEDICARE: JACQUELYN REDENZ LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	PC019162	PA

General Provider Information

NPI Number	:	1477432888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELYN REDENZ LPC, NCC

Provider Business Mailing Address
First Line	:	2707 HOMER AVE
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16506-2521
Country	:	US
Telephone Number	:	814-673-7491
Fax Number	:

Provider Business Practice Location Address
First Line	:	2707 HOMER AVE
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16506-2521
Country	:	US
Telephone Number	:	814-673-7491
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2025
Last Update Date	:	08/29/2025

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