MEDICARE: JENNIFER RYDEN M.ED., 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	1-13-14335	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-13-14335	OTHER		BCBA

General Provider Information

NPI Number	:	1790108363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER RYDEN M.ED., BCBA

Provider Business Mailing Address
First Line	:	PO BOX 639561
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-9561
Country	:	US
Telephone Number	:	844-247-7222
Fax Number	:	215-489-8766

Provider Business Practice Location Address
First Line	:	8008 E ARAPAHOE CT
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80112-6839
Country	:	US
Telephone Number	:	847-247-7222
Fax Number	:	215-489-8766

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

Provider Enumeration Date	:	02/01/2014
Last Update Date	:	08/18/2021

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