Provider Demographics
NPI:1639772387
Name:ANDERSEN, JILLIAN (BCBA)
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10301 RANCH ROAD 2222 APT 2332
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-1274
Mailing Address - Country:US
Mailing Address - Phone:408-857-8586
Mailing Address - Fax:
Practice Address - Street 1:1101 ARROW POINT DR STE 305
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7740
Practice Address - Country:US
Practice Address - Phone:512-605-0069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-20-44734103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst