Provider Demographics
NPI:1043555444
Name:LANHAM, JENNIFER J (BCBA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:LANHAM
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:J
Other - Last Name:SUTHERLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:580 E CARMEL DR STE 310
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3317
Mailing Address - Country:US
Mailing Address - Phone:317-503-3719
Mailing Address - Fax:317-842-5911
Practice Address - Street 1:2344 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-2320
Practice Address - Country:US
Practice Address - Phone:812-901-1173
Practice Address - Fax:812-401-3601
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst