MEDICARE: JENNIFER BRODBECK BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1487323671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER BRODBECK BCBA

Provider Business Mailing Address
First Line	:	1141 LARRY MAHAN DR STE A
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-6517
Country	:	US
Telephone Number	:	915-497-1975
Fax Number	:

Provider Business Practice Location Address
First Line	:	1141 LARRY MAHAN DR STE A
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-6517
Country	:	US
Telephone Number	:	915-312-2756
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/10/2021
Last Update Date	:	06/25/2025

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