Individual
JENNIFER K QUEEN-RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
505 N WABASH AVE, MARION, IN 46952-2608
(765) 662-3971
(765) 662-6726
Mailing address
505 N WABASH AVE, MARION, IN 46952-2608
(765) 662-3971
(765) 662-6726
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34008343A
IN
Other
Enumeration date
12/04/2018
Last updated
12/04/2018
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