Provider Demographics
NPI:1144785759
Name:DILLARD, JENNA RENEE (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:RENEE
Last Name:DILLARD
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 DOUBLEWIDE LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37083-4243
Mailing Address - Country:US
Mailing Address - Phone:615-388-6555
Mailing Address - Fax:
Practice Address - Street 1:2861 HIGHWAY 52 E
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:TN
Practice Address - Zip Code:37083-6029
Practice Address - Country:US
Practice Address - Phone:615-688-9504
Practice Address - Fax:615-688-9503
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRBT-19-76844106S00000X
TN1-24-71035103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician