Individual
MS. JENEI SHANAY MAYBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
218 S 38TH ST, TACOMA, WA 98418-7807
(253) 426-8146
Mailing address
229 E 52ND ST, TACOMA, WA 98404-1386
(253) 344-3289
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111524501
—
WA
Enumeration date
09/22/2018
Last updated
09/22/2018
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