Provider Demographics
NPI:1841154325
Name:WILTSIE, JENNA LYNNE
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:LYNNE
Last Name:WILTSIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CASHEL CT
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-8493
Mailing Address - Country:US
Mailing Address - Phone:904-887-1428
Mailing Address - Fax:
Practice Address - Street 1:12 CASHEL CT
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-8493
Practice Address - Country:US
Practice Address - Phone:904-887-1428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-10
Last Update Date:2025-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician