Provider Demographics
NPI:1790949717
Name:REED, JENNY LYNN (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:LYNN
Last Name:REED
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 1:158 ROAD 944
Mailing Address - Street 2:
Mailing Address - City:MENTONE
Mailing Address - State:AL
Mailing Address - Zip Code:35984-2708
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:158 ROAD 944
Practice Address - Street 2:
Practice Address - City:MENTONE
Practice Address - State:AL
Practice Address - Zip Code:35984-2708
Practice Address - Country:US
Practice Address - Phone:205-388-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-07-3651103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities