Healthcare Provider Details

I. General information

NPI: 1548071574
Provider Name (Legal Business Name): JBC LANGUAGE AND BEHAVIOR THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1967 S CREEKSIDE LN
BOISE ID
83706-4036
US

IV. Provider business mailing address

5895 S HARRINGTON WAY
BOISE ID
83709-6096
US

V. Phone/Fax

Practice location:
  • Phone: 805-668-8957
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA IMGRUND
Title or Position: OWNER
Credential: BCBA
Phone: 630-240-4437