Provider Demographics
NPI:1396016424
Name:JENNIFER S. UNDERWOOD, BCBA
Entity Type:Organization
Organization Name:JENNIFER S. UNDERWOOD, BCBA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:SONMOR
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:334-790-7460
Mailing Address - Street 1:1831 BRACKENBURY PL
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-1753
Mailing Address - Country:US
Mailing Address - Phone:334-790-7460
Mailing Address - Fax:
Practice Address - Street 1:1831 BRACKENBURY PL
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-1753
Practice Address - Country:US
Practice Address - Phone:334-790-7460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-08-4552103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty