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NPI Code Detail

MEDICARE: JENNIFER GREEN

MEDICARE: JENNIFER GREEN
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
1106S00000XBehavior TechnicianSC

General Provider Information

NPI Number : 1184553158
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER GREEN
Provider Business Mailing Address
First Line : 10101 LAKE CARNES LN
Second Line :
City : SUMMERVILLE
State : SC
Zip : 29486-8596
Country : US
Telephone Number : 877-418-2978
Fax Number : 866-500-2186
Provider Business Practice Location Address
First Line : 1320 MAIN ST STE 300
Second Line :
City : COLUMBIA
State : SC
Zip : 29201-3266
Country : US
Telephone Number : 877-418-2978
Fax Number : 866-500-2186
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2026
Last Update Date : 05/15/2026

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Directions to “ JENNIFER GREEN ” Practice Location

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