Provider Demographics
NPI:1316584204
Name:TRONCOZO, JENNIFER (RBT-18-74186)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:TRONCOZO
Suffix:
Gender:F
Credentials:RBT-18-74186
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 GORDON ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79104-3318
Mailing Address - Country:US
Mailing Address - Phone:806-236-3624
Mailing Address - Fax:
Practice Address - Street 1:6031 BELL ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-6618
Practice Address - Country:US
Practice Address - Phone:806-367-9358
Practice Address - Fax:806-500-2772
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-18-74186106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician