Provider Demographics
NPI:1114214103
Name:O'NEILL, JENNIFER LYN IRENE (MA LP BCBA)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYN IRENE
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:MA LP BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 CENTRE POINTE CURVE
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120
Mailing Address - Country:US
Mailing Address - Phone:651-395-5101
Mailing Address - Fax:
Practice Address - Street 1:1150 CENTRE POINTE CURVE
Practice Address - Street 2:
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55120
Practice Address - Country:US
Practice Address - Phone:651-395-5101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
MNLP 5197103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103T00000XBehavioral Health & Social Service ProvidersPsychologist