Individual
MRS. JENNIFER IACAMPO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
150 MANSFIELD AVE, WILLIMANTIC, CT 06226-2026
(860) 456-2232
(860) 456-2256
Mailing address
150 MANSFIELD AVE, WILLIMANTIC, CT 06226-2026
(860) 456-2232
(860) 456-2256
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
008171
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004271003
—
CT
01
—
080008171
ANTHEM BC
CT
Enumeration date
08/20/2007
Last updated
07/12/2012
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