Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PS017029 | PA |
Y | 103T00000X | Psychologist | PS017029 | PA |
N | 103TC1900X | Counseling Psychologist | P0000001892 | TN |
N | 103TC1900X | Counseling Psychologist | PSY001915 | GA |
NPI | 1013931583 |
---|---|
Provider Name | Dr. Jennifer Dawn White |
First Address | Johnstown, PA 15904-3615 |
Second Address | Johnstown, PA 15904-3615 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 01/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3685708 | (02) | PA |
3685708 | (05) | PA |