Provider Demographics
NPI:1447485073
Name:MCDONNER, JENNIFER R (PH D)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:R
Last Name:MCDONNER
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 WASHINGTON AVE
Mailing Address - Street 2:STE. 200
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0805
Mailing Address - Country:US
Mailing Address - Phone:812-479-1916
Mailing Address - Fax:812-479-5014
Practice Address - Street 1:4411 WASHINGTON AVE
Practice Address - Street 2:STE. 200
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0805
Practice Address - Country:US
Practice Address - Phone:812-479-1916
Practice Address - Fax:812-479-5014
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042388A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN444530ZZMedicare PIN