Individual ProviderJenna NicholsBehavior TechnicianBehavioral Health & Social Service ProvidersPractice Address17390 Dugdale Dr Ste 100, South Bend, IN 46635-1512(574) 400-2169PECOS EnrollmentBased on the most recent information from CMS, provider Jenna Nichols does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:33 PM.Profile DetailsProvider ID1346812575Provider TypeIndividualFull NameNichols, JennaCredentialRBTGenderFemaleSole ProprietorNoEnumeration Date7/16/2021Last Updated7/16/2021Contact InformationPractice LocationPractice Address17390 Dugdale Dr Ste 100, South Bend, IN 46635-1512Phone(574) 400-2169Fax(317) 520-8200Mailing LocationMailing Address17390 Dugdale Dr Ste 100, South Bend, IN 46635-1512Phone(574) 400-2169Fax(317) 520-8200Provider TaxonomiesCodeDescriptionLicenseCode106S00000XPrimaryDescriptionBehavior TechnicianBehavioral Health & Social Service ProvidersLicenseRBT-21-176075Michigan