Provider Demographics
NPI:1043962574
Name:WEAVER, JENNA LEA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LEA
Last Name:WEAVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1651 MOUNT ZION RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17406-8342
Mailing Address - Country:US
Mailing Address - Phone:717-885-5906
Mailing Address - Fax:717-600-8179
Practice Address - Street 1:1651 MOUNT ZION RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17406-8342
Practice Address - Country:US
Practice Address - Phone:717-885-5906
Practice Address - Fax:717-600-8179
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARBT-21-184927106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician