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General NPI Number Information
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NPI Number | 1548071574
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Entity Type | Organization
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Legal Business Name | JBC LANGUAGE AND BEHAVIOR THERAPY
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Dates
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Enumeration Date | 01/17/2025
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 1967 S CREEKSIDE LN
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City | BOISE
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State | ID
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Zip | 83706-4036
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Country | US
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Telephone | 805-668-8957
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Fax |
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Provider Business Mailing Address
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Address Line | 5895 S HARRINGTON WAY
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City | BOISE
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State | ID
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Zip | 83709-6096
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINA IMGRUND
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Credential | BCBA
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Telephone | 630-240-4437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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