Provider Demographics
NPI:1235504689
Name:VANALLEN, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:VANALLEN
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:PO BOX 192
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:WI
Mailing Address - Zip Code:53156-0192
Mailing Address - Country:US
Mailing Address - Phone:262-370-5527
Mailing Address - Fax:262-495-8689
Practice Address - Street 1:119 MILL RD
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:WI
Practice Address - Zip Code:53156-9310
Practice Address - Country:US
Practice Address - Phone:262-370-5527
Practice Address - Fax:262-495-8689
Is Sole Proprietor?:No
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst