Provider Demographics
NPI:1013422948
Name:JENNINGS, TAWANNA ANNETTE (RBT-15-05283)
Entity Type:Individual
Prefix:
First Name:TAWANNA
Middle Name:ANNETTE
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:RBT-15-05283
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 HONEYSUCKLE DR
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-3144
Mailing Address - Country:US
Mailing Address - Phone:254-466-2183
Mailing Address - Fax:
Practice Address - Street 1:4008 E STAN SCHLUETER LOOP STE B
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-8548
Practice Address - Country:US
Practice Address - Phone:254-238-1130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-15-05283106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician