Provider Demographics
NPI:1881041895
Name:LENNON, JESSICA KIDD (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:KIDD
Last Name:LENNON
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:KIDD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA, LBA
Mailing Address - Street 1:7108 S KANNER HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7462
Mailing Address - Country:US
Mailing Address - Phone:855-832-6727
Mailing Address - Fax:772-675-9100
Practice Address - Street 1:400 E ROYAL LN STE 290
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-3602
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:772-675-9100
Is Sole Proprietor?:No
Enumeration Date:2016-05-19
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-16-21569103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1618OtherTEXAS DEPARTMENT OF LICENSING & REGULATION - LICENSED BEHAVIOR ANALYST (LBA)
1-16-21569OtherBEHAVIOR ANALYST CERTIFICATION BOARD - BCBA CERTIFICATION