Individual
CHARLES SCOTT JENNISCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6921 HICKMAN RD STE 2327, URBANDALE, IA 50322-4805
(515) 270-2242
Mailing address
6921 HICKMAN RD STE 2327, URBANDALE, IA 50322-4805
(515) 270-2242
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
32533
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1213199
—
IA
01
—
21492
WELLMARK
IA
Enumeration date
09/13/2006
Last updated
07/24/2014
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