Provider Demographics
NPI:1891394094
Name:TRIPLETT, JORDAN (MA, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:TRIPLETT
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 STEPHENS FARM RD
Mailing Address - Street 2:
Mailing Address - City:WHITLEY CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42653-6129
Mailing Address - Country:US
Mailing Address - Phone:606-516-4403
Mailing Address - Fax:
Practice Address - Street 1:630 STEPHENS FARM RD
Practice Address - Street 2:
Practice Address - City:WHITLEY CITY
Practice Address - State:KY
Practice Address - Zip Code:42653-6129
Practice Address - Country:US
Practice Address - Phone:606-516-4403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY266680103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst