Individual
JENNIFER DODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1149 SULLIVAN ST, ELMIRA, NY 14901-1670
(607) 734-2006
Mailing address
458 BEECHER ST # A, ELMIRA, NY 14904-2221
(607) 425-7486
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
01/09/2020
Last updated
01/09/2020
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