Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | CDCA.177531 | OH |
NPI | 1003589953 |
---|---|
Provider Name | Jenna Turek |
First Address | Owings Mills, MD 21117-3902 |
Second Address | Maumee, OH 43537-4009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2021 |
Last Update Date | 27/07/2021 |