Healthcare Provider Details

I. General information

NPI: 1679090419
Provider Name (Legal Business Name): JENNA MARIAH PLOWS MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 US OVAL
PLATTSBURGH NY
12903-5900
US

IV. Provider business mailing address

22 US OVAL
PLATTSBURGH NY
12903-5900
US

V. Phone/Fax

Practice location:
  • Phone: 518-561-1767
  • Fax:
Mailing address:
  • Phone: 518-561-1767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberP07712
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: