Individual
JACKIE E FULLER-WOOSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
T-LMSW
Contact information
Practice address
204 E 15TH ST, OTTAWA, KS 66067-3903
(785) 242-3780
(785) 242-6397
Mailing address
2537 EISENHOWER RD, PO BOX 677, OTTAWA, KS 66067-9482
(785) 242-3780
(785) 242-6397
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
T-LMSW 7563
KS
Other
Enumeration date
08/17/2009
Last updated
08/17/2009
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