Provider Demographics
NPI:1538205448
Name:AMPTMAN, JENNIFER LYNNE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNNE
Last Name:AMPTMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 N TRUMAN BLVD
Mailing Address - Street 2:UPPER LEVEL J
Mailing Address - City:CRYSTAL CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63019-1344
Mailing Address - Country:US
Mailing Address - Phone:314-630-2670
Mailing Address - Fax:314-630-2670
Practice Address - Street 1:508 N TRUMAN BLVD
Practice Address - Street 2:UPPER LEVEL J
Practice Address - City:CRYSTAL CITY
Practice Address - State:MO
Practice Address - Zip Code:63019-1344
Practice Address - Country:US
Practice Address - Phone:314-630-2670
Practice Address - Fax:314-630-2670
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical