Provider Demographics
NPI:1053785873
Name:FAIR, JENNA (RECOVERY COACH)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:FAIR
Suffix:
Gender:F
Credentials:RECOVERY COACH
Other - Prefix:MRS
Other - First Name:JENNA
Other - Middle Name:LYNN
Other - Last Name:SCALISE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RECOVERY COACH
Mailing Address - Street 1:533 RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-2429
Mailing Address - Country:US
Mailing Address - Phone:814-319-6268
Mailing Address - Fax:
Practice Address - Street 1:533 RAILROAD ST
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-2429
Practice Address - Country:US
Practice Address - Phone:814-319-6268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)