Individual
JENNIFER PANNEBAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
813 RANDALL AVE, CHEYENNE, WY 82001
(719) 469-4906
Mailing address
813 RANDALL AVE, CHEYENNE, WY 82001-2559
(719) 469-4906
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-14-9812
FL
Other
Enumeration date
12/16/2016
Last updated
01/06/2020
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