Provider Demographics
NPI:1043511579
Name:LINK, JENNIFER LEE (BCBA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:LINK
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:733 HASTINGS DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-6906
Mailing Address - Country:US
Mailing Address - Phone:224-676-0202
Mailing Address - Fax:844-726-2721
Practice Address - Street 1:733 HASTINGS DR
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-6906
Practice Address - Country:US
Practice Address - Phone:224-676-0202
Practice Address - Fax:844-726-2721
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1-05-2315103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst