Individual
JAQUELYN S KONDROT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
18201 CONNEAUT LAKE RD, MEADVILLE, PA 16335
(814) 333-5060
Mailing address
509 JEFFERSON ST, MEADVILLE, PA 16335-4907
(814) 333-5060
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
PC001647
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PC001647
STATE LICENSE
PA
Enumeration date
08/10/2012
Last updated
10/12/2012
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