Provider Demographics
NPI:1417520859
Name:MARTIN, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:MARTIN
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 1:6105 WINDCOM CT STE 400
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-9003
Mailing Address - Country:US
Mailing Address - Phone:972-312-8733
Mailing Address - Fax:972-307-3242
Practice Address - Street 1:6105 WINDCOM CT STE 400
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-9003
Practice Address - Country:US
Practice Address - Phone:972-312-8733
Practice Address - Fax:972-307-3242
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician