Provider Information for 1194774893
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JENNIFER GRIMES O'BRIEN M.Ed., L.P.C.
Sex: Female
NPI: 1194774893
Last Updated: 2024-11-05
Certification Date: 2024-11-05
Certification Date: 2024-11-05
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1194774893 | ||||||||
| Enumeration Date | 2006-05-09 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1500 W MARKET ST # 1J MEQUON, WI 53092-5098 United States Phone: 414-239-0363 | Fax: | ||||||||
| Primary Practice Address | 1500 W MARKET ST MEQUON, WI 53092-5098 United States Phone: 414-239-0363 | Fax: | ||||||||
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