Provider Demographics
NPI:1467061242
Name:STEVENS, JENNIFER RUTH
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RUTH
Last Name:STEVENS
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 1:9808 SHALLOW CREEK LOOP APT 102
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-5336
Mailing Address - Country:US
Mailing Address - Phone:571-330-4285
Mailing Address - Fax:
Practice Address - Street 1:9808 SHALLOW CREEK LOOP APT 102
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-5336
Practice Address - Country:US
Practice Address - Phone:571-330-4285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician