Provider Demographics
NPI:1538889662
Name:BROWN-GORE, JENNA SIERRA
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:SIERRA
Last Name:BROWN-GORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:S
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5639 IVY KNOLL CT APT C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-3717
Mailing Address - Country:US
Mailing Address - Phone:757-613-0490
Mailing Address - Fax:
Practice Address - Street 1:15570 STONY CREEK WAY
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-4385
Practice Address - Country:US
Practice Address - Phone:317-732-5717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2025-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician