MEDICARE: JBC LANGUAGE AND BEHAVIOR THERAPY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	252Y00000X	Early Intervention Provider Agency
2	261QM1300X	Multi-Specialty Clinic/Center
3	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1548071574
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JBC LANGUAGE AND BEHAVIOR THERAPY

Provider Business Mailing Address
First Line	:	5895 S HARRINGTON WAY
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83709-6096
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1967 S CREEKSIDE LN
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83706-4036
Country	:	US
Telephone Number	:	805-668-8957
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTINA IMGRUND
Credential	:	BCBA
Telephone Number	:	630-240-4437

Provider Enumeration Date	:	01/17/2025
Last Update Date	:	01/17/2025

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Directions to “JBC LANGUAGE AND BEHAVIOR THERAPY ” Practice Location

Language	Start Address	Practice Location

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