Healthcare Provider Details

I. General information

NPI: 1982985859
Provider Name (Legal Business Name): JENNIFER LYNN EDGINGTON M.S. BCBA, LBA, IBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 VALLEY VIEW DR APT 7
COUNCIL BLUFFS IA
51503-6224
US

IV. Provider business mailing address

736 VALLEY VIEW DR APT 7
COUNCIL BLUFFS IA
51503-6224
US

V. Phone/Fax

Practice location:
  • Phone: 319-270-2854
  • Fax:
Mailing address:
  • Phone: 319-270-2854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number1-11-8921
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: