MEDICARE: JENNIFER ROXANNE VASQUEZ M.S., 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-15-21006	OTHER		BCBA CERTIFICATE

General Provider Information

NPI Number	:	1992170047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ROXANNE VASQUEZ M.S., BCBA

Provider Business Mailing Address
First Line	:	300 INTERNATIONAL PKWY STE 200
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-5028
Country	:	US
Telephone Number	:	833-288-4761
Fax Number	:	480-716-8949

Provider Business Practice Location Address
First Line	:	13838 S 46TH PL STE 1626
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-7800
Country	:	US
Telephone Number	:	480-550-9396
Fax Number	:

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

Provider Enumeration Date	:	12/01/2015
Last Update Date	:	05/14/2026

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