Provider Demographics
NPI:1467754408
Name:OUELLETTE, JENNIFER (LCPC,LADC,LSW,CCS)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:OUELLETTE
Suffix:
Gender:F
Credentials:LCPC,LADC,LSW,CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:ALFRED
Mailing Address - State:ME
Mailing Address - Zip Code:04002-0820
Mailing Address - Country:US
Mailing Address - Phone:207-324-1137
Mailing Address - Fax:207-324-7316
Practice Address - Street 1:147 SHAKER HILL RD
Practice Address - Street 2:
Practice Address - City:ALFRED
Practice Address - State:ME
Practice Address - Zip Code:04002-3253
Practice Address - Country:US
Practice Address - Phone:207-324-1137
Practice Address - Fax:207-324-7316
Is Sole Proprietor?:No
Enumeration Date:2010-11-24
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME230721171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator