Provider Demographics
NPI:1821238262
Name:FERRAIOLO, JENNA (LAC)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:FERRAIOLO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:FERRAIOLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:107 CHESLEY DR STE 5C
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1760
Mailing Address - Country:US
Mailing Address - Phone:610-674-0577
Mailing Address - Fax:
Practice Address - Street 1:107 CHESLEY DR STE 5C
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1760
Practice Address - Country:US
Practice Address - Phone:610-674-0577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12926171100000X
PAOM000247171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty