Individual
MISS JENNIFER ELLEN TISDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
30 OLD LYMAN RD, SOUTH HADLEY, MA 01075-2630
(413) 533-7140
Mailing address
18 KEEFE AVE, HOLYOKE, MA 01040-2213
(413) 536-8287
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
S60873821
MA
Other
Enumeration date
11/29/2007
Last updated
11/29/2007
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