Provider Demographics
NPI:1306180666
Name:NINCI, JENNIFER M (MED, BCBA)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:M
Last Name:NINCI
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-5215
Mailing Address - Country:US
Mailing Address - Phone:979-776-2872
Mailing Address - Fax:
Practice Address - Street 1:1318 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-5215
Practice Address - Country:US
Practice Address - Phone:979-776-2872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-12-12662103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst