1083413942 NPI number — MRS. JENNIFER LYNNE STOTTLAR LMSW

Table of content: MRS. JENNIFER LYNNE STOTTLAR LMSW (NPI 1083413942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083413942 NPI number — MRS. JENNIFER LYNNE STOTTLAR LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOTTLAR
Provider First Name:
JENNIFER
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CORNISH
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
LYNNE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083413942
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 N WASHINGTON STREET
Provider Second Line Business Mailing Address:
SUITE 2470
Provider Business Mailing Address City Name:
HERKIMER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-867-1465
Provider Business Mailing Address Fax Number:
315-867-1469

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 N WASHINGTON STREET
Provider Second Line Business Practice Location Address:
SUITE 2470
Provider Business Practice Location Address City Name:
HERKIMER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-867-1465
Provider Business Practice Location Address Fax Number:
315-867-1469
Provider Enumeration Date:
03/12/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  124368 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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