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NPI Code Detail

MEDICARE: COLLEEN JENNY BCBA

MEDICARE: COLLEEN JENNY BCBA
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
1106E00000XAssistant Behavior AnalystFL
2103K00000XBehavior Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225427008
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLLEEN JENNY BCBA
Provider Business Mailing Address
First Line : 1763 BAYSHORE BLVD
Second Line :
City : DUNEDIN
State : FL
Zip : 34698-3342
Country : US
Telephone Number : 704-930-9647
Fax Number :
Provider Business Practice Location Address
First Line : 5447 E BEAUMONT CENTER BLVD
Second Line :
City : TAMPA
State : FL
Zip : 33634-5210
Country : US
Telephone Number : 954-866-5345
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2015
Last Update Date : 12/27/2024

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