Provider Demographics
NPI:1730877697
Name:CHURCH, JANA RAE (IECE)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:RAE
Last Name:CHURCH
Suffix:
Gender:F
Credentials:IECE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 DWIGHT ST
Mailing Address - Street 2:
Mailing Address - City:FLATWOODS
Mailing Address - State:KY
Mailing Address - Zip Code:41139-9026
Mailing Address - Country:US
Mailing Address - Phone:606-585-3716
Mailing Address - Fax:
Practice Address - Street 1:361 WINDBURN LN
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-8372
Practice Address - Country:US
Practice Address - Phone:606-475-9564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-28
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist