Provider Demographics
NPI:1699347849
Name:CROSSLEY, JENNIFER (RBT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:CROSSLEY
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 1:1160 S UNION AVE # 1160
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:AL
Mailing Address - Zip Code:36360-2660
Mailing Address - Country:US
Mailing Address - Phone:334-477-6283
Mailing Address - Fax:
Practice Address - Street 1:1880 S UNION AVE
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:AL
Practice Address - Zip Code:36360-2898
Practice Address - Country:US
Practice Address - Phone:334-443-1043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician