Provider Demographics
NPI:1154755783
Name:ARVIDSON, JENNIFER LEE (CCLS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:ARVIDSON
Suffix:
Gender:F
Credentials:CCLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 STONEYBROOK DR
Mailing Address - Street 2:APARTMENT 6
Mailing Address - City:MILLIS
Mailing Address - State:MA
Mailing Address - Zip Code:02054-1626
Mailing Address - Country:US
Mailing Address - Phone:401-714-5758
Mailing Address - Fax:
Practice Address - Street 1:42 STONEYBROOK DR
Practice Address - Street 2:APARTMENT 6
Practice Address - City:MILLIS
Practice Address - State:MA
Practice Address - Zip Code:02054-1626
Practice Address - Country:US
Practice Address - Phone:401-714-5758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program