Provider Demographics
NPI:1922624238
Name:DAVIS, JENNIFER ANN (LBA, BCBA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LBA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 ADVENTURELAND DR
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-2237
Mailing Address - Country:US
Mailing Address - Phone:515-991-7609
Mailing Address - Fax:
Practice Address - Street 1:1625 ADVENTURELAND DR
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-2237
Practice Address - Country:US
Practice Address - Phone:515-991-7609
Practice Address - Fax:515-957-3380
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA098549103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst