Provider Demographics
NPI:1790108363
Name:RYDEN, JENNIFER (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:RYDEN
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 639561
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-9561
Mailing Address - Country:US
Mailing Address - Phone:844-247-7222
Mailing Address - Fax:215-489-8766
Practice Address - Street 1:8008 E ARAPAHOE CT
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-6839
Practice Address - Country:US
Practice Address - Phone:847-247-7222
Practice Address - Fax:215-489-8766
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-01
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-13-14335103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-13-14335OtherBCBA