Provider Demographics
NPI:1164072625
Name:DIETZ, JENNY (BCBA)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:DIETZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 MANHEIM PIKE STE 2
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-3064
Mailing Address - Country:US
Mailing Address - Phone:717-945-6491
Mailing Address - Fax:
Practice Address - Street 1:1630 MANHEIM PIKE STE 2
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-3064
Practice Address - Country:US
Practice Address - Phone:717-945-6491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABCBAOther1-18-33192