Provider Demographics
NPI:1134416308
Name:SMITH, JENNIFER LYNN (PSYD, LPC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:PSYD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:17100 W NORTH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4450
Mailing Address - Country:US
Mailing Address - Phone:262-786-9184
Mailing Address - Fax:262-786-1906
Practice Address - Street 1:17100 W NORTH AVE STE 100
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4450
Practice Address - Country:US
Practice Address - Phone:262-786-9184
Practice Address - Fax:262-786-1906
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5389-125101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional