Provider Demographics
NPI:1053146639
Name:BLOCK, JENNA K
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:K
Last Name:BLOCK
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 1:15 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6267
Mailing Address - Country:US
Mailing Address - Phone:843-949-9596
Mailing Address - Fax:
Practice Address - Street 1:3924 FOREST DR STE 3
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4148
Practice Address - Country:US
Practice Address - Phone:803-258-0533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician