Individual
JENIECE GENTRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
732 BECKMAN ST, DAYTON, OH 45410-2165
(937) 250-2154
Mailing address
732 BECKMAN ST, DAYTON, OH 45410-2165
(937) 250-2154
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
172401
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
172401
—
OH
Enumeration date
12/27/2019
Last updated
12/27/2019
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