Healthcare Provider Details

I. General information

NPI: 1992170047
Provider Name (Legal Business Name): JENNIFER ROXANNE VASQUEZ M.S., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13838 S 46TH PL STE 1626
PHOENIX AZ
85044-7800
US

IV. Provider business mailing address

300 INTERNATIONAL PKWY STE 200
LAKE MARY FL
32746-5028
US

V. Phone/Fax

Practice location:
  • Phone: 480-550-9396
  • Fax:
Mailing address:
  • Phone: 833-288-4761
  • Fax: 480-716-8949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: