Provider Demographics
NPI:1356791107
Name:BEDNAREK, JENNA (QASP)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:BEDNAREK
Suffix:
Gender:F
Credentials:QASP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 NEW LAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453
Mailing Address - Country:US
Mailing Address - Phone:812-374-2168
Mailing Address - Fax:
Practice Address - Street 1:4224 HOLLAND RD
Practice Address - Street 2:106
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-2345
Practice Address - Country:US
Practice Address - Phone:757-416-5290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst