Provider Demographics
NPI:1205518362
Name:DEAN, JAUNELLA MICHELE (CPHT)
Entity type:Individual
Prefix:
First Name:JAUNELLA
Middle Name:MICHELE
Last Name:DEAN
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 N HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-6596
Mailing Address - Country:US
Mailing Address - Phone:463-644-7714
Mailing Address - Fax:
Practice Address - Street 1:2610 N HILLS BLVD
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-6596
Practice Address - Country:US
Practice Address - Phone:469-644-7714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator