Individual
JACOB FANCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
112 SARTIN DR, EDMONTON, KY 42129-8170
(270) 901-5000
(270) 842-5268
Mailing address
380 SUWANNEE TRAIL ST, BOWLING GREEN, KY 42103-7956
(270) 901-5000
(270) 842-5268
Taxonomy
Speciality
Code
Description
License number
State
225C00000X
Rehabilitation Counselor
Primary
—
—
Other
Enumeration date
11/12/2019
Last updated
11/12/2019
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