Provider Demographics
NPI:1275706814
Name:PEACOCK, JENNIFER APRIL (MSW, BCBA)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:APRIL
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:MSW, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1557 BEAVER TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-6021
Mailing Address - Country:US
Mailing Address - Phone:901-488-0427
Mailing Address - Fax:901-308-1159
Practice Address - Street 1:1557 BEAVER TRAIL DR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-6021
Practice Address - Country:US
Practice Address - Phone:901-488-0427
Practice Address - Fax:901-308-1159
Is Sole Proprietor?:No
Enumeration Date:2008-04-03
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-11-8819103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst