Provider Demographics
NPI:1194515346
Name:MADRID, JEANA LEE ANNE
Entity type:Individual
Prefix:
First Name:JEANA
Middle Name:LEE ANNE
Last Name:MADRID
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:937 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-5845
Mailing Address - Country:US
Mailing Address - Phone:817-415-2759
Mailing Address - Fax:
Practice Address - Street 1:937 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5845
Practice Address - Country:US
Practice Address - Phone:817-415-2579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-10
Last Update Date:2025-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst