MEDICARE: JEANEDEE CASEM MALENAB BCBA

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	1-20-45441	TX

General Provider Information

NPI Number	:	1770933616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANEDEE CASEM MALENAB BCBA

Provider Business Mailing Address
First Line	:	3550 PARKWOOD BLVD STE 205A
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75034-1904
Country	:	US
Telephone Number	:	972-521-9060
Fax Number	:

Provider Business Practice Location Address
First Line	:	5400 W PLANO PKWY
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-4852
Country	:	US
Telephone Number	:	972-665-7251
Fax Number	:	855-568-2494

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

Provider Enumeration Date	:	06/21/2016
Last Update Date	:	11/11/2022

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