Provider Demographics
NPI:1073693271
Name:GATHERCOLE, JENNIFER L (MA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:GATHERCOLE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 MARTIN RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03280-3534
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17 93RD ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3748
Practice Address - Country:US
Practice Address - Phone:603-924-7236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor