MEDICARE: JENNIFER YOUNG QASP

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	106E00000X	Assistant Behavior Analyst	8241	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RBT-15-10623	OTHER		REGISTERED BEHAVIOR TECHNICIAN (RBT) THROUGH BACB
2	8241	OTHER		QUALIFIED AUTISM SERVICES PROVIDER (QASP) CERTIFICATION THROUGH QABA

General Provider Information

NPI Number	:	1689125510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER YOUNG QASP

Provider Business Mailing Address
First Line	:	2000 CHEATHAM DAM RD
Second Line	:
City	:	CHARLOTTE
State	:	TN
Zip	:	37036-5033
Country	:	US
Telephone Number	:	615-545-0864
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 CHEATHAM DAM RD
Second Line	:
City	:	CHARLOTTE
State	:	TN
Zip	:	37036-5033
Country	:	US
Telephone Number	:	615-545-0864
Fax Number	:

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

Provider Enumeration Date	:	10/15/2016
Last Update Date	:	10/15/2016

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