Jae LLC

NPI #1376088435 in Edwardsville, Pennsylvania

Provider Information

NPI Number: 1376088435
Entity Type: Organization
Organization Name: Jae LLC
Primary Specialty: Doula
Enumeration Date: Dec 28, 2016
Last Updated: Dec 28, 2016

Practice Location

Address: 512 NORTHHAMPTON STREET
City: Edwardsville
State: Pennsylvania
ZIP Code: 18704
Phone: (570) 212-9520

Authorized Official

Name: MS. JESSICA ANN ENRIQUEZ, LMT
Title: DOULA/LICENSED MASSAGE THERAPIST
Phone: (570) 299-9247

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Massage Therapist	225700000X
Doula	374J00000X	Primary

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