MEDICARE: JENNIFER HARRISON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst		CA

General Provider Information

NPI Number	:	1114420288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER HARRISON

Provider Business Mailing Address
First Line	:	PO BOX 740780
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-0780
Country	:	US
Telephone Number	:	855-223-7123
Fax Number	:

Provider Business Practice Location Address
First Line	:	5701 W TALAVI BLVD
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85306-1886
Country	:	US
Telephone Number	:	855-223-7123
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2018
Last Update Date	:	04/10/2026

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Directions to “ JENNIFER HARRISON ” Practice Location

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