Provider Demographics
NPI:1871954818
Name:VAN WIEREN, JENNIFER MARIE (LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:VAN WIEREN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 PHILADELPHIA ST
Mailing Address - Street 2:THEATER BUILDING, SUITE 402
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3919
Mailing Address - Country:US
Mailing Address - Phone:724-762-4759
Mailing Address - Fax:
Practice Address - Street 1:637 PHILADELPHIA ST
Practice Address - Street 2:THEATER BUILDING, SUITE 402
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3919
Practice Address - Country:US
Practice Address - Phone:724-762-4759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-18
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008731101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional