Provider Demographics
NPI:1013316017
Name:SANT-WING, JENNA FAITH (BCBA)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:FAITH
Last Name:SANT-WING
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3995 MARCOLA RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-7948
Mailing Address - Country:US
Mailing Address - Phone:541-726-1465
Mailing Address - Fax:541-726-5085
Practice Address - Street 1:7839 UNIVERSITY AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-0476
Practice Address - Country:US
Practice Address - Phone:951-813-4034
Practice Address - Fax:951-813-4035
Is Sole Proprietor?:No
Enumeration Date:2014-08-15
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0146013103K00000X
CA1-16-21381103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst