Provider Demographics
NPI:1316364805
Name:SHUBERT, JENNIFER SUSAN (PH D, BCBA)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:SUSAN
Last Name:SHUBERT
Suffix:
Gender:F
Credentials:PH D, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5604 SOUTHWEST PKWY APT 1923
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-6252
Mailing Address - Country:US
Mailing Address - Phone:512-636-5467
Mailing Address - Fax:
Practice Address - Street 1:921 W NEW HOPE DR
Practice Address - Street 2:SUITES 404/405
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-6784
Practice Address - Country:US
Practice Address - Phone:512-636-5467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-14-15419103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst