Healthcare Provider Details

I. General information

NPI: 1487430245
Provider Name (Legal Business Name): JENNA MARY ELIZABETH GREENWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNA MARY ELIZABETH MUNYER

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2028 W 11TH ST
UPLAND CA
91786-3509
US

IV. Provider business mailing address

2028 W 11TH ST
UPLAND CA
91786-3509
US

V. Phone/Fax

Practice location:
  • Phone: 888-515-1793
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License NumberLABA.AB.70131636
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: