Provider Information for 1669107264
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KATHERINE E JODREY CGC
Sex: Female
NPI: 1669107264
Last Updated: 2022-07-19
Certification Date: 2022-07-19
Certification Date: 2022-07-19
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1669107264 | ||||||||
| Enumeration Date | 2022-07-19 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1624 MAPLETON AVE SUFFIELD, CT 06078-1431 United States Phone: 774-641-2799 | Fax: | ||||||||
| Primary Practice Address | 263 FARMINGTON AVE FARMINGTON, CT 06030-0001 United States Phone: 860-679-2000 | Fax: | ||||||||
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