Provider Demographics
NPI:1033725676
Name:JENNY WAMSAT, PSY.D., PLLC
Entity type:Organization
Organization Name:JENNY WAMSAT, PSY.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WAMSAT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:872-225-6391
Mailing Address - Street 1:1921 W DIVERSEY PKWY APT 402
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-9412
Mailing Address - Country:US
Mailing Address - Phone:872-225-6391
Mailing Address - Fax:
Practice Address - Street 1:1921 W DIVERSEY PKWY APT 402
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-9412
Practice Address - Country:US
Practice Address - Phone:872-225-6391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health