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Individual

JENNIFER ANN DOUGLAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
TREATMENT TRAINEE 1

Contact information

Practice address
510 HARTBROOK DR STE 202, HARTLAND, WI 53029-1415
(262) 361-4275
Mailing address
510 HARTBROOK DR STE 202, HARTLAND, WI 53029-1415
(262) 361-4275

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
1528364825
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
472230426
WI
Enumeration date
11/29/2021
Last updated
12/06/2021
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