Individual
JESSICA EARLYWINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
500 WILLOW AVE, SUITE 305, COUNCIL BLUFFS, IA 51503-0827
(712) 256-4420
(712) 256-4423
Mailing address
500 WILLOW AVE, SUITE 305, COUNCIL BLUFFS, IA 51503-0827
(712) 256-4420
(712) 256-4423
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
073332
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
073332
—
IA
Enumeration date
06/16/2014
Last updated
06/16/2014
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