Provider Demographics
NPI:1497262463
Name:DUPUIS, JENNIFER RAE (BCBA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RAE
Last Name:DUPUIS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:RAE
Other - Last Name:PARSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1105 W RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-1322
Mailing Address - Country:US
Mailing Address - Phone:605-271-2690
Mailing Address - Fax:605-271-3956
Practice Address - Street 1:945 PENDELL BLVD
Practice Address - Street 2:
Practice Address - City:MILLS
Practice Address - State:WY
Practice Address - Zip Code:82644-8264
Practice Address - Country:US
Practice Address - Phone:307-215-1032
Practice Address - Fax:605-271-3956
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst