Provider Demographics
NPI:1740866094
Name:JEPSON, JENELLE LYNN (RBT)
Entity type:Individual
Prefix:
First Name:JENELLE
Middle Name:LYNN
Last Name:JEPSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5084
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-0117
Mailing Address - Country:US
Mailing Address - Phone:541-810-0884
Mailing Address - Fax:
Practice Address - Street 1:2421 WASHBURN WAY STE 2631
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-4525
Practice Address - Country:US
Practice Address - Phone:541-885-1675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician