Provider Demographics
NPI:1659775625
Name:ACKERMAN, JEANNEMARIE
Entity Type:Individual
Prefix:
First Name:JEANNEMARIE
Middle Name:
Last Name:ACKERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 QUARRY HILL CT
Mailing Address - Street 2:
Mailing Address - City:HENNIKER
Mailing Address - State:NH
Mailing Address - Zip Code:03242-3449
Mailing Address - Country:US
Mailing Address - Phone:603-459-2795
Mailing Address - Fax:603-459-2783
Practice Address - Street 1:34 QUARRY HILL CT
Practice Address - Street 2:
Practice Address - City:HENNIKER
Practice Address - State:NH
Practice Address - Zip Code:03242-3449
Practice Address - Country:US
Practice Address - Phone:603-459-2795
Practice Address - Fax:603-459-2783
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1-07-3725103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst