Provider Demographics
NPI:1821895947
Name:CANNON, JAVAUN
Entity type:Individual
Prefix:
First Name:JAVAUN
Middle Name:
Last Name:CANNON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2719 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4528
Mailing Address - Country:US
Mailing Address - Phone:989-315-4414
Mailing Address - Fax:989-393-5974
Practice Address - Street 1:2719 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4528
Practice Address - Country:US
Practice Address - Phone:989-315-4414
Practice Address - Fax:989-393-5974
Is Sole Proprietor?:No
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician