MEDICARE: MISS JENNIFER APRIL PEACOCK MSW, 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
1	103K00000X	Behavior Analyst	1-11-8819	TN

General Provider Information

NPI Number	:	1275706814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JENNIFER APRIL PEACOCK MSW, BCBA

Provider Business Mailing Address
First Line	:	5154 OLIVER GROVE LN
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38002-9000
Country	:	US
Telephone Number	:	901-488-0427
Fax Number	:

Provider Business Practice Location Address
First Line	:	5154 OLIVER GROVE LN
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38002-9000
Country	:	US
Telephone Number	:	901-488-0427
Fax Number	:

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

Provider Enumeration Date	:	04/03/2008
Last Update Date	:	11/11/2025

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