Healthcare Provider Details

I. General information

NPI: 1598636698
Provider Name (Legal Business Name): JENNIFER DOTSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2025
Last Update Date: 09/13/2025
Certification Date: 09/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3341 S OATES ST
DOTHAN AL
36301-5889
US

IV. Provider business mailing address

3341 S OATES ST
DOTHAN AL
36301-5889
US

V. Phone/Fax

Practice location:
  • Phone: 334-405-1942
  • Fax:
Mailing address:
  • Phone: 334-405-1942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-470656
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: