Provider Demographics
NPI:1104537711
Name:BAILEY, JENNA RENEE (RBT)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:RENEE
Last Name:BAILEY
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 1:2210 FLAGLER PROMENADE WAY APT 201
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-8692
Mailing Address - Country:US
Mailing Address - Phone:410-707-9747
Mailing Address - Fax:
Practice Address - Street 1:7200 LAKE ELLENOR DR STE 205
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-5788
Practice Address - Country:US
Practice Address - Phone:305-406-3689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician