Provider Demographics
NPI:1427559921
Name:BICKERTON, JENNIFER (RBT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BICKERTON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6608
Mailing Address - Country:US
Mailing Address - Phone:805-979-9941
Mailing Address - Fax:805-222-3041
Practice Address - Street 1:1112 S BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-6608
Practice Address - Country:US
Practice Address - Phone:805-979-9941
Practice Address - Fax:805-222-3041
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-18-48875103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst