Provider Demographics
NPI:1205238607
Name:SWAN, JENA LEIGH (MA, BCBA)
Entity type:Individual
Prefix:MISS
First Name:JENA
Middle Name:LEIGH
Last Name:SWAN
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 SHADOW RUN DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95110-3550
Mailing Address - Country:US
Mailing Address - Phone:408-829-0079
Mailing Address - Fax:
Practice Address - Street 1:373 SHADOW RUN DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95110-3550
Practice Address - Country:US
Practice Address - Phone:408-829-0079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-15231103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst