Individual
AUTUMN RENEE JACQUETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LGSW
Contact information
Practice address
5878 HENRY AVE, ROCK HALL, MD 21661-1342
(410) 310-8917
Mailing address
PO BOX 591, ROCK HALL, MD 21661-0591
(410) 310-8917
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
21142
MD
Other
Enumeration date
09/02/2016
Last updated
06/25/2021
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