Individual
MRS. JAELEE ANN FETROW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
509 COLORADO AVE, SUITE B, PUEBLO, CO 81004-2008
(719) 334-9324
Mailing address
509 COLORADO AVE, SUITE B, PUEBLO, CO 81004-2008
(719) 334-9324
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW992806
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
CO
Enumeration date
05/09/2008
Last updated
05/09/2008
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