Healthcare Provider Details

I. General information

NPI: 1376815126
Provider Name (Legal Business Name): JENNIFER HARTMAN BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER LONSDORF BCBA

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8609 W BRYN MAWR AVE STE 204
CHICAGO IL
60631-3524
US

IV. Provider business mailing address

8609 W BRYN MAWR AVE STE 204
CHICAGO IL
60631-3524
US

V. Phone/Fax

Practice location:
  • Phone: 773-726-1416
  • Fax: 224-241-3132
Mailing address:
  • Phone: 773-726-1416
  • Fax: 224-241-3132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-09-5816
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: