Provider Demographics
NPI:1376724153
Name:WILCZENSKI, JENNIFER K (LIC AC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:WILCZENSKI
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 LOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTONVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1615
Mailing Address - Country:US
Mailing Address - Phone:781-249-2069
Mailing Address - Fax:
Practice Address - Street 1:34 COUNTRY WAY
Practice Address - Street 2:COUNTRY WAY HEALTH
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066
Practice Address - Country:US
Practice Address - Phone:781-249-2069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA228811171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist