Individual
JENNIFER HATHAWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
417 WILLIS AVE, BRIDGEPORT, WV 26330-1551
(304) 677-8714
Mailing address
417 WILLIS AVE, BRIDGEPORT, WV 26330-1551
(304) 677-8714
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
07/17/2024
Last updated
07/17/2024
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