Individual
JENNEE DEE ALLAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2854 E KEELING RD, HEREFORD, AZ 85615-9633
(520) 803-0131
Mailing address
2854 E KEELING RD, HEREFORD, AZ 85615-9633
(520) 803-0131
Taxonomy
Speciality
Code
Description
License number
State
385HR2055X
Child Mental Illness Respite Care
Primary
997726
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
997726
FOSTER CARE LICENSE ID NUMBER
AZ
Enumeration date
07/24/2008
Last updated
07/24/2008
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