Provider Demographics
NPI:1144526427
Name:HATTERMAN, JENNIFER MARIE (LADC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:HATTERMAN
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6105 CROCKERY ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-1067
Mailing Address - Country:US
Mailing Address - Phone:702-515-1889
Mailing Address - Fax:702-515-1889
Practice Address - Street 1:3630 N RANCHO DR STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3111
Practice Address - Country:US
Practice Address - Phone:702-645-2544
Practice Address - Fax:702-823-4358
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV683-L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)