Provider Demographics
NPI:1669820999
Name:HERRIN, JAMIE (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:HERRIN
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3372 US HIGHWAY 82
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31523-7701
Mailing Address - Country:US
Mailing Address - Phone:847-922-1475
Mailing Address - Fax:
Practice Address - Street 1:3372 US HIGHWAY 82
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31523-7701
Practice Address - Country:US
Practice Address - Phone:847-922-1475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0166974103K00000X
1-16-24768103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst