Individual
JESSICA LYNN CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1095 MIDWAY RD, MENASHA, WI 54952-1115
(920) 720-2300
(920) 720-3719
Mailing address
1095 MIDWAY RD, MENASHA, WI 54952-1115
(920) 720-3700
(920) 720-3860
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
7474
WI
Other
Enumeration date
07/09/2012
Last updated
07/09/2012
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