Individual
JENNIFER MICHELLE FAST WOLF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
111 S SECOND ST, GALLUP, NM 87301-6219
(505) 409-0726
Mailing address
138 E 960 S APT S102, VERNAL, UT 84078-3396
(435) 219-2656
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
12/08/2018
Last updated
12/08/2018
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