Healthcare Provider Details

I. General information

NPI: 1124520465
Provider Name (Legal Business Name): JENNIFER MARIE THOMPSON BCBA, COBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

314 HILL POND RD
BLUFFTON SC
29910-4586
US

IV. Provider business mailing address

314 HILL POND RD
BLUFFTON SC
29910-4586
US

V. Phone/Fax

Practice location:
  • Phone: 330-620-9627
  • Fax:
Mailing address:
  • Phone: 330-620-9627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberCOBA.00380
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA000264
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBACB304746
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: