| NPI | 1578121208 |
|---|---|
| Former Name | JENNIFER ANN MCCLAIRE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 16303) |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2019-05-29 |