Provider Demographics
NPI:1144835208
Name:PROUSE, JAYDEN A
Entity type:Individual
Prefix:MISS
First Name:JAYDEN
Middle Name:A
Last Name:PROUSE
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 1:5774 ROYAL MILE BLVD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-2325
Mailing Address - Country:US
Mailing Address - Phone:443-614-3407
Mailing Address - Fax:
Practice Address - Street 1:5774 ROYAL MILE BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-2325
Practice Address - Country:US
Practice Address - Phone:443-614-3407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician