Provider Demographics
NPI:1609415371
Name:STEFFEN, JEZEBEL RAE (RBT)
Entity type:Individual
Prefix:
First Name:JEZEBEL
Middle Name:RAE
Last Name:STEFFEN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:JEZEBEL
Other - Middle Name:
Other - Last Name:POWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 668
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47402
Mailing Address - Country:US
Mailing Address - Phone:812-330-4460
Mailing Address - Fax:812-330-4461
Practice Address - Street 1:227 W GRIMES LN
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403
Practice Address - Country:US
Practice Address - Phone:812-322-0313
Practice Address - Fax:812-330-4461
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-19-104415106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician