MEDICARE: MARGARET MADELINE JENNETT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1215890991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET MADELINE JENNETT

Provider Business Mailing Address
First Line	:	6731 GRANADA RD NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-8424
Country	:	US
Telephone Number	:	814-933-4857
Fax Number	:	814-933-4857

Provider Business Practice Location Address
First Line	:	6731 GRANADA RD NE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87144-8424
Country	:	US
Telephone Number	:	814-933-4857
Fax Number	:	814-933-4857

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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