Individual
JENNIFER DETLEFSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC, MHA
Contact information
Practice address
57 LONG MEADOW RD, BETHLEHEM, CT 06751-1116
(203) 405-3369
Mailing address
57 LONG MEADOW RD, BETHLEHEM, CT 06751-1116
(203) 405-3369
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
764
CT
Other
Enumeration date
11/29/2017
Last updated
11/29/2017
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