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Individual

MS. JODI BETH JACQUES

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.S.

Contact information

Practice address
11-21 BROADWAY ST, GLOVERSVILLE, NY 12078-3968
(518) 725-4310
Mailing address
400 MCCHESNEY AVE EXT, 4-10, TROY, NY 12180-8801
(518) 225-4215

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary

Other

Enumeration date
07/13/2006
Last updated
07/08/2007
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