Provider Demographics
NPI:1699338533
Name:JENNINGS, SUSAN LEE
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:LEE
Last Name:JENNINGS
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 1:300 PROMENADE BLVD APT 2124
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-2864
Mailing Address - Country:US
Mailing Address - Phone:702-830-2922
Mailing Address - Fax:
Practice Address - Street 1:7608 NARROW PASS ST
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3019
Practice Address - Country:US
Practice Address - Phone:210-714-3545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician