Provider Demographics
NPI:1619643871
Name:KREJCHA, JEANIE RENEE (RBT)
Entity Type:Individual
Prefix:
First Name:JEANIE
Middle Name:RENEE
Last Name:KREJCHA
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 LAKEVIEW RESERVE BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-2516
Mailing Address - Country:US
Mailing Address - Phone:262-989-3622
Mailing Address - Fax:
Practice Address - Street 1:15675 ORANGE HARVEST LOOP
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3199
Practice Address - Country:US
Practice Address - Phone:407-505-9071
Practice Address - Fax:407-487-4229
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-21-180393106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician