| NPI | 1801368493 |
|---|---|
| Former Name | JENNA M SIDES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 135092) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 20765) |
| Enumeration Date | 2018-12-20 |
| Last Update Date | 2025-02-13 |