Individual
MRS. JEANICE L POLWORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED, LPC
Contact information
Practice address
2112 E MAPLE AVE, ENID, OK 73701-4612
(580) 747-2289
(580) 234-3553
Mailing address
2112 E MAPLE AVE, ENID, OK 73701-4612
(580) 747-2289
(580) 234-3553
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
4412
OK
Other
Enumeration date
07/29/2008
Last updated
09/20/2010
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