| NPI | 1245589787 |
|---|---|
| Former Name | JENNIFER DEROUSSEAU |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 8230-123) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 16080-132) |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2021-05-10 |