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NPI Code Detail

MEDICARE: JENNIFER LYNNE COLLIER MA, BCBA, LBA

MEDICARE: JENNIFER LYNNE COLLIER MA, 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
1103K00000XBehavior Analyst7401002356MI

General Provider Information

NPI Number : 1871359661
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER LYNNE COLLIER MA, BCBA, LBA
Provider Business Mailing Address
First Line : 511 E IRVING AVE APT 103
Second Line :
City : MADISON HEIGHTS
State : MI
Zip : 48071-1959
Country : US
Telephone Number : 248-607-2375
Fax Number :
Provider Business Practice Location Address
First Line : 30701 BARRINGTON ST STE 150
Second Line :
City : MADISON HEIGHTS
State : MI
Zip : 48071-5135
Country : US
Telephone Number : 248-965-9371
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2024
Last Update Date : 02/28/2024

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