Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | CC4222 | ME |
NPI | 1245607753 |
---|---|
Provider Name | Jeannie Vezina Wood |
First Address | Portland, ME 04103-1070 |
Second Address | Biddeford, ME 04005-5507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2015 |
Last Update Date | 01/09/2015 |