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NPI Code Detail

MEDICARE: JESSICA KIDD LENNON BCBA, LBA

MEDICARE: JESSICA KIDD LENNON 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 Analyst1-16-21569TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11618OTHERTXTEXAS DEPARTMENT OF LICENSING & REGULATION - LICENSED BEHAVIOR ANALYST (LBA)
21-16-21569OTHERBEHAVIOR ANALYST CERTIFICATION BOARD - BCBA CERTIFICATION

General Provider Information

NPI Number : 1881041895
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA KIDD LENNON BCBA, LBA
Provider Business Mailing Address
First Line : 7108 S KANNER HWY
Second Line :
City : STUART
State : FL
Zip : 34997-7462
Country : US
Telephone Number : 855-832-6727
Fax Number : 772-675-9100
Provider Business Practice Location Address
First Line : 320 DECKER DRIVE
Second Line :
City : IRVING
State : TX
Zip : 75062-3999
Country : US
Telephone Number : 855-832-6727
Fax Number : 772-675-9100
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2016
Last Update Date : 11/04/2025

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