| Doctor Name: | JENNIE CONRAD |
| NPI Number: | 1326256710 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMHC, NCC |
| License Number: | 39001595A |
| Business Practice Address: | 3563 S State Road 13 Wabash, IN - 469929162 |
| Business Phone Number: | 2605638452 |
| Business Fax Number: | 2605690335 |
| Mailing Address: | 3563 S State Road 13, WABASH |
| State: | IN |
| Postal Code: | 469929162 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 05/18/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 39001595A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |