Provider Demographics
NPI:1114605102
Name:FLEWELLEN, JAZMYNN (BCBA)
Entity Type:Individual
Prefix:
First Name:JAZMYNN
Middle Name:
Last Name:FLEWELLEN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 IVYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1788
Mailing Address - Country:US
Mailing Address - Phone:678-216-6290
Mailing Address - Fax:
Practice Address - Street 1:6385 MCGINNIS FERRY RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3621
Practice Address - Country:US
Practice Address - Phone:470-508-9575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst