Provider Demographics
NPI:1679218515
Name:CROSS, JADAYA
Entity Type:Individual
Prefix:
First Name:JADAYA
Middle Name:
Last Name:CROSS
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 1:7760 FRANCE AVE S FL 11
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5930
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:7760 FRANCE AVE S FL 11
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55435-5930
Practice Address - Country:US
Practice Address - Phone:651-529-0510
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician