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General NPI Number Information
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NPI Number | 1265299606
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Entity Type | Individual
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Provider Name | JACEE SUE FREEMAN
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Gender | Female
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Dates
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Enumeration Date | 03/04/2024
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Last Update Date | 03/04/2024
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Provider Practice Location Address
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Address Line | 30 ONYX DR
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City | GREENBRIER
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State | AR
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Zip | 72058-9148
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Country | US
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Telephone | 501-380-0028
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Fax |
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Provider Business Mailing Address
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Address Line | 1284 JOHNSON LN
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City | DELAWARE
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State | AR
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Zip | 72835-9104
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Country | US
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Telephone | 501-242-3258
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | 23-319084
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License Number State | AR
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