MEDICARE: JENNY LYNN DAVIS MS, BCBA, 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	105810	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	105810	OTHER	IA	IOWA STATE BOARD OF BEHAVIORAL SCIENCE

General Provider Information

NPI Number	:	1679922231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY LYNN DAVIS MS, BCBA, LBA

Provider Business Mailing Address
First Line	:	28 STURGIS CORNER DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52246-5617
Country	:	US
Telephone Number	:	319-351-5524
Fax Number	:	319-351-5754

Provider Business Practice Location Address
First Line	:	28 STURGIS CORNER DR
Second Line	:
City	:	IOWA CITY
State	:	IA
Zip	:	52246-5617
Country	:	US
Telephone Number	:	319-351-5524
Fax Number	:	319-351-5754

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

Provider Enumeration Date	:	06/05/2016
Last Update Date	:	10/09/2023

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