Individual
JORDAN LYN FENNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4907 HILLSIDE DR, WEST BEND, WI 53095-9255
(262) 224-5151
(262) 224-5151
Mailing address
4907 HILLSIDE DR, WEST BEND, WI 53095-9255
(262) 224-5151
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
11/10/2017
Last updated
11/10/2017
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