Provider Demographics
NPI:1093204075
Name:LAYTON, JENNA (RBT)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:LAYTON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10277 W 52ND PL UNIT 210
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6624
Mailing Address - Country:US
Mailing Address - Phone:815-353-2684
Mailing Address - Fax:
Practice Address - Street 1:10277 W 52ND PL UNIT 210
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6624
Practice Address - Country:US
Practice Address - Phone:815-353-2684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-06
Last Update Date:2018-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-17-45730106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician