Doctor Name: | JENNY ANN INGRAM |
NPI Number: | 1033379516 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | BA, CSAC, IDP-AT |
License Number: | 14547-131 |
Business Practice Address: | 13380 W Trepania Rd Hayward, WI - 548432186 |
Business Phone Number: | 7156385116 |
Business Fax Number: | 7156386107 |
Mailing Address: | 13380 W Trepania Rd, HAYWARD |
State: | WI |
Postal Code: | 548432186 |
Phone Number: | 7156385116 |
Fax Number: | 7156386107 |
NPI Enumeration Date: | 06/10/2008 |
NPI Last Update Date: | 05/09/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 14547-131 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |