Provider Demographics
NPI:1760617740
Name:SMITH, JENNIFER LYNNE (PHD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:LYNNE
Other - Last Name:SIMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, BCBA-D
Mailing Address - Street 1:2107 NEW HAMPSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-3047
Mailing Address - Country:US
Mailing Address - Phone:479-206-3131
Mailing Address - Fax:855-860-1954
Practice Address - Street 1:2107 NEW HAMPSHIRE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-3047
Practice Address - Country:US
Practice Address - Phone:479-206-3131
Practice Address - Fax:855-860-1954
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100407920AMedicaid