Provider Demographics
NPI:1184112914
Name:LORDS, JENNIFER F (BCBA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:F
Last Name:LORDS
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 1:4133 BROKEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89445-4172
Mailing Address - Country:US
Mailing Address - Phone:435-841-7523
Mailing Address - Fax:
Practice Address - Street 1:4133 BROKEN HILL RD
Practice Address - Street 2:
Practice Address - City:WINNEMUCCA
Practice Address - State:NV
Practice Address - Zip Code:89445-4172
Practice Address - Country:US
Practice Address - Phone:435-841-7523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLBA0128103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst