Provider Demographics
NPI:1104583954
Name:BIXLER, JENELLE RENAE
Entity type:Individual
Prefix:MRS
First Name:JENELLE
Middle Name:RENAE
Last Name:BIXLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JENELLE
Other - Middle Name:RENAE
Other - Last Name:LOTTNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BEHAVIOR TECHNICIAN
Mailing Address - Street 1:WESTSIDE CHILDREN'S THERAPY
Mailing Address - Street 2:1725 S NAPERVILLE RD STE 110
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189
Mailing Address - Country:US
Mailing Address - Phone:630-509-4911
Mailing Address - Fax:
Practice Address - Street 1:21000 S FRANKFORT SQUARE RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-9385
Practice Address - Country:US
Practice Address - Phone:815-469-1500
Practice Address - Fax:815-220-5619
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician