Healthcare Provider Details

I. General information

NPI: 1992618110
Provider Name (Legal Business Name): JENNIFER JOSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 ACCUTECH WAY
MUNCIE IN
47304-9462
US

IV. Provider business mailing address

4938 CLARKSON DR
INDIANAPOLIS IN
46254-4197
US

V. Phone/Fax

Practice location:
  • Phone: 765-282-8222
  • Fax:
Mailing address:
  • Phone: 317-657-6670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: