Provider Demographics
NPI:1629314166
Name:KOS, JENNIFER LEA (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEA
Last Name:KOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 3RD ST # F1
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2356
Mailing Address - Country:US
Mailing Address - Phone:330-398-4823
Mailing Address - Fax:855-938-3274
Practice Address - Street 1:347 3RD ST # F1
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2356
Practice Address - Country:US
Practice Address - Phone:330-398-4823
Practice Address - Fax:855-938-3274
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS020566103TC0700X
OHP.07678103TC0700X
PAPC006662101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional