Provider Demographics
NPI:1033684436
Name:REYNOLDS, JENNA ANN (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:ANN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:ANN
Other - Last Name:KURZAWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:1601 S MOPAC EXPY STE C300
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-7077
Mailing Address - Country:US
Mailing Address - Phone:512-920-1030
Mailing Address - Fax:512-256-1983
Practice Address - Street 1:2730 S VAL VISTA DR BLDG 4
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1675
Practice Address - Country:US
Practice Address - Phone:480-608-4640
Practice Address - Fax:602-926-0352
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ001082103K00000X
IL11938038103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-19-38038OtherBCBA CERTIFICATE
AZBEH-001082OtherAZ PSYCH BOARD