MEDICARE: JENNA ROSE PALL

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	1441	TN

General Provider Information

NPI Number	:	1598278681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA ROSE PALL

Provider Business Mailing Address
First Line	:	3500 DEPAUW BLVD STE 3070
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-6135
Country	:	US
Telephone Number	:	855-324-0885
Fax Number	:	317-520-8200

Provider Business Practice Location Address
First Line	:	68 EXETER RD
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305-1829
Country	:	US
Telephone Number	:	731-201-1486
Fax Number	:	317-520-8200

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

Provider Enumeration Date	:	11/10/2017
Last Update Date	:	02/16/2024

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Directions to “ JENNA ROSE PALL ” Practice Location

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