Healthcare Provider Details

I. General information

NPI: 1972124519
Provider Name (Legal Business Name): ALYCIA JENSEN M.A., BCBA, COBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 05/23/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 E WILSON BRIDGE RD STE 200
WORTHINGTON OH
43085-2391
US

IV. Provider business mailing address

130 E WILSON BRIDGE RD STE 200
WORTHINGTON OH
43085-2391
US

V. Phone/Fax

Practice location:
  • Phone: 614-681-1030
  • Fax:
Mailing address:
  • Phone: 614-681-1030
  • Fax:

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: