Provider Demographics
NPI:1891060844
Name:BADE, JENNIFER EILEEN
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:EILEEN
Last Name:BADE
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 1:4214 SANDY SHORES DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-9700
Mailing Address - Country:US
Mailing Address - Phone:813-310-4319
Mailing Address - Fax:
Practice Address - Street 1:4214 SANDY SHORES DR
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-9700
Practice Address - Country:US
Practice Address - Phone:813-310-4319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst