Provider Demographics
NPI:1285200873
Name:SEDDENS, TANESHA JANEEN
Entity Type:Individual
Prefix:
First Name:TANESHA
Middle Name:JANEEN
Last Name:SEDDENS
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 1:216 MORRIS ST
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08030-1445
Mailing Address - Country:US
Mailing Address - Phone:856-956-9680
Mailing Address - Fax:
Practice Address - Street 1:407 GLENN AVE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-6109
Practice Address - Country:US
Practice Address - Phone:856-733-0811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNA106S00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician