Healthcare Provider Details

I. General information

NPI: 1134604994
Provider Name (Legal Business Name): JENNIFER ROSE HARMON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2018
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S WINCHESTER BLVD STE N260
SAN JOSE CA
95128
US

IV. Provider business mailing address

1550 VISTA CLUB CIR APT 301
SANTA CLARA CA
95054-3761
US

V. Phone/Fax

Practice location:
  • Phone: 269-625-6710
  • Fax:
Mailing address:
  • Phone: 269-625-6710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: