Provider Demographics
NPI:1619348992
Name:AUSTIN, JILLIAN (PHD, BCBA)
Entity Type:Individual
Prefix:DR
First Name:JILLIAN
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:PHD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4371 FERGUSON DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-1668
Mailing Address - Country:US
Mailing Address - Phone:513-752-3650
Mailing Address - Fax:
Practice Address - Street 1:4371 FERGUSON DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1668
Practice Address - Country:US
Practice Address - Phone:513-752-3650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-13
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHP.07914103TC2200X
OH128-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst