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General NPI Number Information
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NPI Number | 1407221294
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Entity Type | Individual
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Provider Name | VONDA JAN PERRY
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Gender | Female
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Dates
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Enumeration Date | 12/06/2015
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Last Update Date | 12/06/2015
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Provider Practice Location Address
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Address Line | 7119 BRISTOL MEADOW LN
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City | MEMPHIS
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State | TN
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Zip | 38125-4289
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Country | US
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Telephone | 901-491-6653
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Fax |
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Provider Business Mailing Address
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Address Line | 210 S MCLEAN BLVD APT 3
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City | MEMPHIS
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State | TN
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Zip | 38104-6119
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Country | US
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Telephone | 901-907-5544
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-14-9426
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License Number State | TN
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