Provider Demographics
NPI:1346263795
Name:WOLEN, JESSICA LYN (CTRS)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYN
Last Name:WOLEN
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:MANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08835-1622
Mailing Address - Country:US
Mailing Address - Phone:908-595-0047
Mailing Address - Fax:
Practice Address - Street 1:151 KNOLLCROFT RD
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:NJ
Practice Address - Zip Code:07939-5001
Practice Address - Country:US
Practice Address - Phone:908-647-0180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist