MEDICARE: KRISTEN JEFFRIES LBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1174297147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN JEFFRIES LBA

Provider Business Mailing Address
First Line	:	9722 GROFFS MILL DR STE 766
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-6341
Country	:	US
Telephone Number	:	330-301-1763
Fax Number	:

Provider Business Practice Location Address
First Line	:	9722 GROFFS MILL DR STE 766
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-6341
Country	:	US
Telephone Number	:	330-301-1763
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2021
Last Update Date	:	06/01/2026

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Directions to “ KRISTEN JEFFRIES LBA” Practice Location

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