Provider Demographics
NPI:1265299606
Name:FREEMAN, JACEE SUE
Entity type:Individual
Prefix:
First Name:JACEE
Middle Name:SUE
Last Name:FREEMAN
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 1:1284 JOHNSON LN
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:AR
Mailing Address - Zip Code:72835-9104
Mailing Address - Country:US
Mailing Address - Phone:501-242-3258
Mailing Address - Fax:
Practice Address - Street 1:30 ONYX DR
Practice Address - Street 2:
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-9148
Practice Address - Country:US
Practice Address - Phone:501-380-0028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR23-319084106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician