Provider Demographics
NPI:1063120970
Name:DJANISON, JENNIFER E
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:DJANISON
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 1:6960 EXETER CT APT 304
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-2865
Mailing Address - Country:US
Mailing Address - Phone:631-355-6870
Mailing Address - Fax:
Practice Address - Street 1:6960 EXETER CT APT 304
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-2865
Practice Address - Country:US
Practice Address - Phone:631-355-6870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty