Individual
MRS. JENNIFER ALICE TATTERSALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
62 BROADWAY STE 1, NORWICH, CT 06360-5702
(860) 639-6880
Mailing address
62 BROADWAY STE 1, NORWICH, CT 06360-5702
(860) 639-6880
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
005582
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004255396
—
CT
Enumeration date
11/02/2006
Last updated
02/06/2019
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