Provider Demographics
NPI:1487017430
Name:LEON, JENNA
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:LEON
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 1:13434 FOUNTAINBLEAU DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5954
Mailing Address - Country:US
Mailing Address - Phone:407-373-8714
Mailing Address - Fax:
Practice Address - Street 1:7600 DR PHILLIPS BLVD STE 72
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7238
Practice Address - Country:US
Practice Address - Phone:407-730-5969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician