MEDICARE: JENNIFER MAXON

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	103K00000X	Behavior Analyst
2	103K00000X	Behavior Analyst	0-17-7935	CA

General Provider Information

NPI Number	:	1821518291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MAXON

Provider Business Mailing Address
First Line	:	4316 W POINT LOMA BLVD APT F
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92107-1171
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4316 W POINT LOMA BLVD APT F
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92107-1171
Country	:	US
Telephone Number	:	619-252-5566
Fax Number	:

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

Provider Enumeration Date	:	06/26/2017
Last Update Date	:	06/26/2017

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Directions to “ JENNIFER MAXON ” Practice Location

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