Provider Demographics
NPI:1336484625
Name:MICHAUD, JENNIFER ANN (LCPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:MICHAUD
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 DOW HWY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ELIOT
Mailing Address - State:ME
Mailing Address - Zip Code:03903-2056
Mailing Address - Country:US
Mailing Address - Phone:603-767-8156
Mailing Address - Fax:
Practice Address - Street 1:178 DOW HWY
Practice Address - Street 2:SUITE 3
Practice Address - City:ELIOT
Practice Address - State:ME
Practice Address - Zip Code:03903-2056
Practice Address - Country:US
Practice Address - Phone:603-767-8156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC4555101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional