Provider Demographics
NPI:1720659501
Name:MAU, JENELLE MARIE (RBT)
Entity Type:Individual
Prefix:MRS
First Name:JENELLE
Middle Name:MARIE
Last Name:MAU
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:JENELLE
Other - Middle Name:MARIE
Other - Last Name:CURTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:777 N CRUSEY ST STE B108
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34851 KENAI SPUR HWY STE 2
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7646
Practice Address - Country:US
Practice Address - Phone:401-203-3110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician