Provider Demographics
NPI:1205697653
Name:JENNES THERAPY
Entity type:Organization
Organization Name:JENNES THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-269-0418
Mailing Address - Street 1:5693 S REDWOOD RD UNIT 13
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-5494
Mailing Address - Country:US
Mailing Address - Phone:385-269-0418
Mailing Address - Fax:
Practice Address - Street 1:5693 S REDWOOD RD UNIT 13
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84123-5494
Practice Address - Country:US
Practice Address - Phone:385-269-0418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty