Basic Information
| Provider Information | |||||||||
| NPI: | 1447699798 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GINDLESPERGER | ||||||||
| FirstName: | JENA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3010 7TH AVE | ||||||||
| Address2: | |||||||||
| City: | ALTOONA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166021906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8145255276 | ||||||||
| FaxNumber: | 8149429725 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 LAKEMONT PARK BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ALTOONA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166025967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8149460261 | ||||||||
| FaxNumber: | 8145691189 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2013 | ||||||||
| LastUpdateDate: | 05/02/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.