| NPI | 1588368252 |
|---|---|
| Former Name | JENNIFER SEVERSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 5465-226) |
| Additional Taxonomies | 225600000X Dance Therapist (Licence: WI 17-37) |
| Enumeration Date | 2023-03-28 |
| Last Update Date | 2023-03-28 |