Provider Demographics
NPI:1679226237
Name:MCCONNELL, JENNIFER H
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:H
Last Name:MCCONNELL
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 1:3597 S BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-7401
Mailing Address - Country:US
Mailing Address - Phone:856-875-6233
Mailing Address - Fax:
Practice Address - Street 1:3597 S BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08094-7401
Practice Address - Country:US
Practice Address - Phone:856-875-6233
Practice Address - Fax:856-875-4415
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ13VH01296900171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications