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NPI Code Detail

MEDICARE: MOLLIE LYNN JEANES

MEDICARE: MOLLIE LYNN JEANES
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 Technician

General Provider Information

NPI Number : 1609735513
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOLLIE LYNN JEANES
Provider Business Mailing Address
First Line : 5220 6TH STREET FRONTAGE RD E STE 1700
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62703-5771
Country : US
Telephone Number : 217-525-8332
Fax Number :
Provider Business Practice Location Address
First Line : 650 OFFICE PKWY
Second Line :
City : CREVE COEUR
State : MO
Zip : 63141-7103
Country : US
Telephone Number : 217-525-8332
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2026
Last Update Date : 01/16/2026

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