Provider Demographics
NPI:1447518295
Name:SELEGUE, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SELEGUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36415 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-5221
Mailing Address - Country:US
Mailing Address - Phone:951-445-3899
Mailing Address - Fax:
Practice Address - Street 1:414 TENNESSEE ST
Practice Address - Street 2:SUITE Y
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8163
Practice Address - Country:US
Practice Address - Phone:909-798-9547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-30
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor