Healthcare Provider Details

I. General information

NPI: 1043725302
Provider Name (Legal Business Name): JENNA FARLEY RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNA BILLINGTON

II. Dates (important events)

Enumeration Date: 12/08/2017
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3568 GERAGHTY AVE
FAIRBANKS AK
99709-4701
US

IV. Provider business mailing address

3568 GERAGHTY AVE
FAIRBANKS AK
99709-4701
US

V. Phone/Fax

Practice location:
  • Phone: 907-374-7001
  • Fax: 907-374-7008
Mailing address:
  • Phone: 907-374-7001
  • Fax: 907-374-7008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number158152
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: