The holder whose full name is Hanslow, Jacque De Anne,come from Lafayette IN,hold the Temp Mental Hlth Coun Permit license(NO.99019076A) which status is Superceded.
| Name | Hanslow, Jacque De Anne |
|---|---|
| License Number | 99019076A |
| License Type | Temp Mental Hlth Coun Permit |
| License Status | Superceded |
| City | Lafayette |
| State | IN |