Provider Demographics
NPI:1417836271
Name:FUSON, JADIE (RBT)
Entity type:Individual
Prefix:
First Name:JADIE
Middle Name:
Last Name:FUSON
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CAVETTON LN APT 25D
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4114
Mailing Address - Country:US
Mailing Address - Phone:615-708-7291
Mailing Address - Fax:
Practice Address - Street 1:8930 CROSS PARK DR STE 1
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4713
Practice Address - Country:US
Practice Address - Phone:865-407-2983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician