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General NPI Number Information
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NPI Number | 1205296027
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Entity Type | Individual
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Provider Name | JENNIFER RICHMOND BCBA
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Gender | Female
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Dates
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Enumeration Date | 03/07/2016
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Last Update Date | 02/15/2024
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Provider Practice Location Address
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Address Line | 507 S NELSON ST
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City | GREENVILLE
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State | MI
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Zip | 48838-2197
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Country | US
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Telephone | 616-303-9787
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Fax |
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Provider Business Mailing Address
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Address Line | 503 S MAIN ST
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City | CRYSTAL
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State | MI
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Zip | 48818-9657
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Country | US
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Telephone | 989-287-2699
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 7401000757
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-17-27067
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License Number State | MI
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