MEDICARE: DR. JENNIFER THOMAS PH.D., BCBA-D

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	1-15-20888	MI
2	103TC0700X	Clinical Psychologist	6301011058	MI

General Provider Information

NPI Number	:	1528427135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER THOMAS PH.D., BCBA-D

Provider Business Mailing Address
First Line	:	8548 DOWNING ST
Second Line	:
City	:	WASHINGTON
State	:	MI
Zip	:	48094-3951
Country	:	US
Telephone Number	:	586-747-7327
Fax Number	:

Provider Business Practice Location Address
First Line	:	8548 DOWNING ST
Second Line	:
City	:	WASHINGTON
State	:	MI
Zip	:	48094-3951
Country	:	US
Telephone Number	:	586-747-7327
Fax Number	:

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

Provider Enumeration Date	:	02/11/2016
Last Update Date	:	02/11/2016

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