Provider Demographics
NPI:1811238330
Name:DERRING, JENNA A
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:A
Last Name:DERRING
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 1:63 KEYSTONE AVE
Mailing Address - Street 2:SUITE # 304
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-5577
Mailing Address - Country:US
Mailing Address - Phone:775-333-5222
Mailing Address - Fax:
Practice Address - Street 1:63 KEYSTONE AVE
Practice Address - Street 2:SUITE #304
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-5577
Practice Address - Country:US
Practice Address - Phone:775-333-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst