Most Relevant Information
Provider Data
| NPI Number: | 1003336512 |
| Provider Name: | JENNIFER COPPEDGE |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/26/2017 |
| Last Updated: | 06/26/2017 |
Provider Practice Location
4158 W US HIGHWAY 90 STE 101
LAKE CITY
FL
320554883
Practice Location Phone/Fax
| Phone: | 3522846057 |
| Fax: |
Provider Mailing Location
4158 W US HIGHWAY 90 STE 101
LAKE CITY
FL
320554883
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |