Provider Demographics
NPI:1316690936
Name:ZELLER, JENNA MOON
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:MOON
Last Name:ZELLER
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 1:1196 BAKKER RD
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49444-3911
Mailing Address - Country:US
Mailing Address - Phone:248-935-4898
Mailing Address - Fax:
Practice Address - Street 1:1196 BAKKER RD
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-3911
Practice Address - Country:US
Practice Address - Phone:248-935-4898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-02
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician