Provider Demographics
NPI:1235536863
Name:FRENCH, JENNA (BCBA)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:FRENCH
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 1:2230 RANCHVIEW LN N
Mailing Address - Street 2:#95
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-6468
Mailing Address - Country:US
Mailing Address - Phone:757-274-3331
Mailing Address - Fax:
Practice Address - Street 1:9001 E BLOOMINGTON FWY
Practice Address - Street 2:SUITE 143
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-3435
Practice Address - Country:US
Practice Address - Phone:952-777-4996
Practice Address - Fax:952-777-2004
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-25
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-14-10092103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-14-10092OtherBCBA CERTIFICATE