Individual
MISS JENNIFER ALIDA IWANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
55 CALVIN ST, WEST SPRINGFIELD, MA 01089-2859
(413) 363-3004
Mailing address
55 CALVIN ST, WEST SPRINGFIELD, MA 01089-2859
(413) 363-3004
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101Y00000X
COUNSELOR- USE FOR BA STAFF
MA
Enumeration date
06/02/2014
Last updated
06/02/2014
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