Provider Demographics
NPI:1447826888
Name:SIEGEL, JANA
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:SIEGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 SHEILA BLVD
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36066-6022
Mailing Address - Country:US
Mailing Address - Phone:732-403-1734
Mailing Address - Fax:
Practice Address - Street 1:306 CAMELLIA DR
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36067-2631
Practice Address - Country:US
Practice Address - Phone:334-363-3359
Practice Address - Fax:334-625-1853
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRBT-20-130960106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician