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General NPI Number Information
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NPI Number | 1538679881
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Entity Type | Individual
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Provider Name | JAIME WINSLOW
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Gender | Female
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Dates
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Enumeration Date | 10/01/2017
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Last Update Date | 03/18/2020
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Provider Practice Location Address
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Address Line | 777 E ALOSTA AVE
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City | AZUSA
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State | CA
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Zip | 91702-3102
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Country | US
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Telephone | 949-412-4602
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Fax |
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Provider Business Mailing Address
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Address Line | 410 HUMPHREYS WAY
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City | GLENDORA
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State | CA
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Zip | 91741-2928
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT114505
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License Number State | CA
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