Most Relevant Information
Provider Data
| NPI Number: | 1003589573 |
| Provider Name: | JENNIFER THIEKE |
| Entity Type: | Individual |
| Taxonomy Code: | 104100000X |
| Specialty: | Social Worker |
| License Number: | 052481-01 |
Most Important Dates
| Enumeration Date: | 07/29/2021 |
| Last Updated: | 07/29/2021 |
Provider Practice Location
6 COACH HILL LN
NORTHPORT
NY
117683308
Practice Location Phone/Fax
| Phone: | 6314024124 |
| Fax: |
Provider Mailing Location
6 COACH HILL LN
NORTHPORT
NY
117683308
Provider Mailing Phone/Fax
| Phone: | 6314024124 |
| Fax: |