Provider Demographics
NPI:1629577754
Name:ABRAHAMSON, JENNA MARIE (MED, BCBA, COBA)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:ABRAHAMSON
Suffix:
Gender:F
Credentials:MED, BCBA, COBA
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:REZES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1117 WESTOVER RD
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-9063
Mailing Address - Country:US
Mailing Address - Phone:146-448-8846
Mailing Address - Fax:
Practice Address - Street 1:6460 CENTERVILLE BUSINESS PKWY
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-2633
Practice Address - Country:US
Practice Address - Phone:937-265-8151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOBA.00503103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-18-33340OtherBCBA CERTIFICATE