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NPI Code Detail

MEDICARE: JENNA MANN

MEDICARE: JENNA MANN
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 TechnicianRBT-21-167393GA
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1861066912
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNA MANN
Provider Business Mailing Address
First Line : 402B LEGACY PARK
Second Line :
City : RIDGELAND
State : MS
Zip : 39157-4315
Country : US
Telephone Number : 769-233-7154
Fax Number :
Provider Business Practice Location Address
First Line : 402B LEGACY PARK
Second Line :
City : RIDGELAND
State : MS
Zip : 39157-4315
Country : US
Telephone Number : 769-233-7154
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2021
Last Update Date : 07/05/2023

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Directions to “ JENNA MANN ” Practice Location

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