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NPI Code Detail

MEDICARE: JENEE DANIELE POLK

MEDICARE: JENEE DANIELE POLK
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
1106S00000XBehavior TechnicianLA

General Provider Information

NPI Number : 1669290532
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENEE DANIELE POLK
Provider Business Mailing Address
First Line : 10510 JOOR RD STE 300A
Second Line :
City : BATON ROUGE
State : LA
Zip : 70818-3925
Country : US
Telephone Number : 225-960-2403
Fax Number :
Provider Business Practice Location Address
First Line : 10510 JOOR RD STE 300A
Second Line :
City : BATON ROUGE
State : LA
Zip : 70818-3925
Country : US
Telephone Number : 225-960-2403
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2024
Last Update Date : 09/30/2024

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Directions to “ JENEE DANIELE POLK ” Practice Location

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