Healthcare Provider Details

I. General information

NPI: 1700268380
Provider Name (Legal Business Name): JENNIFER L SHARPE M.A., B.C.B.A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9155 N SANTA MONICA BLVD
BAYSIDE WI
53217-1758
US

IV. Provider business mailing address

9155 N SANTA MONICA BLVD
BAYSIDE WI
53217-1758
US

V. Phone/Fax

Practice location:
  • Phone: 414-460-1445
  • Fax:
Mailing address:
  • Phone: 414-460-1445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number110-140
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: