Provider Demographics
NPI:1528580339
Name:KELLER, JENNIFER PILLARD (BCBA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PILLARD
Last Name:KELLER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:KELLER
Other - Last Name:BERKELEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LBA
Mailing Address - Street 1:3515 STUART AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-2112
Mailing Address - Country:US
Mailing Address - Phone:434-851-0955
Mailing Address - Fax:
Practice Address - Street 1:12310 BAILEY BRIDGE RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-3118
Practice Address - Country:US
Practice Address - Phone:804-739-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0133000190103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst