Provider Demographics
NPI:1366209249
Name:OLSEN, JENNIFER PARKER (MS, LPMHC, NCC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:PARKER
Last Name:OLSEN
Suffix:
Gender:F
Credentials:MS, LPMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 MEDALLION DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-3207
Mailing Address - Country:US
Mailing Address - Phone:585-402-3762
Mailing Address - Fax:
Practice Address - Street 1:130 ALLENS CREEK RD STE 240
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3305
Practice Address - Country:US
Practice Address - Phone:585-206-2631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP115952101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health