Provider Demographics
NPI:1861081689
Name:SIMMONS, JENNIFER JEANNE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEANNE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:JEANNE
Other - Last Name:KOMENDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9076 LAKE AVON DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829-8838
Mailing Address - Country:US
Mailing Address - Phone:309-287-5752
Mailing Address - Fax:
Practice Address - Street 1:9076 LAKE AVON DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32829-8838
Practice Address - Country:US
Practice Address - Phone:309-287-5752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-15
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-23-14386106E00000X
106S00000X
FL1-24-71426103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician