| NPI | 1669245650 |
|---|---|
| Former Name | JENNA MAE RICK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 305783) |
| Enumeration Date | 2023-11-01 |
| Last Update Date | 2023-11-01 |