Provider Demographics
NPI:1588897466
Name:MIROSLAW, JENNIFER ANN (MS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:MIROSLAW
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7145 FREMSTED RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:WI
Mailing Address - Zip Code:54830-8764
Mailing Address - Country:US
Mailing Address - Phone:715-416-2186
Mailing Address - Fax:
Practice Address - Street 1:7145 FREMSTED RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:WI
Practice Address - Zip Code:54830-8764
Practice Address - Country:US
Practice Address - Phone:715-416-2186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health