Provider Demographics
NPI:1104362896
Name:STAUFFER, JENNA (MS)
Entity type:Individual
Prefix:MS
First Name:JENNA
Middle Name:
Last Name:STAUFFER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S FREMONT AVE
Mailing Address - Street 2:BUILDING A-5, SUITE 5128
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-8800
Mailing Address - Country:US
Mailing Address - Phone:626-407-0740
Mailing Address - Fax:626-407-0799
Practice Address - Street 1:1000 S FREMONT AVE
Practice Address - Street 2:BUILDING A-5, SUITE 5128
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-8800
Practice Address - Country:US
Practice Address - Phone:626-407-0740
Practice Address - Fax:626-407-0799
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst