Individual
MS. WENDELA REGINA JISKOOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW LICSW
Contact information
Practice address
57 FRANKLIN ST, BRISTOL, RI 02809
(401) 253-3130
Mailing address
57 FRANKLIN ST, BRISTOL, RI 02809
(401) 253-3130
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
107136
MA
1041C0700X
Clinical Social Worker
Primary
ISW00079
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6212005
UBH
RI
01
—
74841
BC & BS OR RI
RI
Enumeration date
06/29/2006
Last updated
07/08/2007
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