Healthcare Provider Details

I. General information

NPI: 1023892833
Provider Name (Legal Business Name): JENNA FRANKLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 FRANKLIN AVE STE L500
NORMAL IL
61761-3551
US

IV. Provider business mailing address

1302 FRANKLIN AVE STE L500
NORMAL IL
61761-3551
US

V. Phone/Fax

Practice location:
  • Phone: 309-452-0069
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-292853
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: