Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker |
NPI | 1003401696 |
---|---|
Provider Name | Jennifer Geraldine Porras Palacios |
First Address | Madison, TN 37115-2866 |
Second Address | Madison, TN 37115-2866 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2021 |
Last Update Date | 04/03/2021 |