Provider Demographics
NPI:1023642824
Name:DIEMAN, JENNIFER KAY (MED, LPCC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KAY
Last Name:DIEMAN
Suffix:
Gender:F
Credentials:MED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 THOMAS MORE PKWY STE 160
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5460
Mailing Address - Country:US
Mailing Address - Phone:859-600-6990
Mailing Address - Fax:859-927-3171
Practice Address - Street 1:350 THOMAS MORE PKWY STE 160
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-5460
Practice Address - Country:US
Practice Address - Phone:859-600-6990
Practice Address - Fax:859-927-3171
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY287106101YM0800X
KY247184101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health