Provider Demographics
NPI:1245624832
Name:SLENDEBROEK, JODY (BCBA)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:SLENDEBROEK
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 1:4001 BARNER AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-3414
Mailing Address - Country:US
Mailing Address - Phone:707-315-9462
Mailing Address - Fax:
Practice Address - Street 1:2560 9TH STREET SUITE 220A
Practice Address - Street 2:STE CONSULTANTS LLC
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710
Practice Address - Country:US
Practice Address - Phone:510-665-9700
Practice Address - Fax:510-665-9400
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-14-9974103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst