Individual
JENNIFER DUCLOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5175 OLD CLEMMONS SCHOOL ROAD, WINSTON-SALEM, NC 27102-4020
(704) 780-4271
(704) 788-2016
Mailing address
418B W MOUNTAIN ST, KERNERSVILLE, NC 27284-2534
(704) 780-4271
(888) 261-6694
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
106S00000X
Behavior Technician
—
—
222Q00000X
Developmental Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
021564700
—
FL
Enumeration date
06/14/2017
Last updated
09/23/2021
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