Provider Demographics
NPI:1871994418
Name:AELING, JENNIFER ANNETTE (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANNETTE
Last Name:AELING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E VETERANS STREET
Mailing Address - Street 2:MH ADMIN
Mailing Address - City:TOMAH
Mailing Address - State:WI
Mailing Address - Zip Code:54660
Mailing Address - Country:US
Mailing Address - Phone:608-372-3971
Mailing Address - Fax:608-372-3971
Practice Address - Street 1:500 E VETERANS STREET
Practice Address - Street 2:MH ADMIN
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660
Practice Address - Country:US
Practice Address - Phone:608-372-3971
Practice Address - Fax:608-372-3971
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6442103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical