Provider Demographics
NPI:1689014680
Name:ROOKS, JENNY (M ED BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:
Last Name:ROOKS
Suffix:
Gender:F
Credentials:M ED BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2192 WAVERLY CT
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-3900
Mailing Address - Country:US
Mailing Address - Phone:303-921-7007
Mailing Address - Fax:
Practice Address - Street 1:1365 LYNDHURST WAY
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2584
Practice Address - Country:US
Practice Address - Phone:770-952-8534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-12-11705103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst