MEDICARE: JENNIFER BROWN 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	1-20-43433	TX

General Provider Information

NPI Number	:	1760094114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER BROWN BCBA

Provider Business Mailing Address
First Line	:	4159 SARASOTA SPRINGS CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-1465
Country	:	US
Telephone Number	:	210-262-5859
Fax Number	:

Provider Business Practice Location Address
First Line	:	4159 SARASOTA SPRINGS CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-1465
Country	:	US
Telephone Number	:	210-262-5859
Fax Number	:

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

Provider Enumeration Date	:	08/18/2020
Last Update Date	:	08/18/2020

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