Provider Demographics
NPI:1902056575
Name:WHATLEY, JENNIFER J (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:J
Last Name:WHATLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6008 ABERFELDY CT
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8344
Mailing Address - Country:US
Mailing Address - Phone:614-356-0787
Mailing Address - Fax:
Practice Address - Street 1:6008 ABERFELDY CT
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8344
Practice Address - Country:US
Practice Address - Phone:614-356-0787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6476103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2928765Medicaid