Provider Demographics
NPI:1255616488
Name:GREGORY, JODI (BCBA)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:
Last Name:GREGORY
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 1:221 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:AVOCA
Mailing Address - State:PA
Mailing Address - Zip Code:18641-1507
Mailing Address - Country:US
Mailing Address - Phone:570-335-0357
Mailing Address - Fax:
Practice Address - Street 1:221 GROVE ST
Practice Address - Street 2:
Practice Address - City:AVOCA
Practice Address - State:PA
Practice Address - Zip Code:18641-1507
Practice Address - Country:US
Practice Address - Phone:570-335-0357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst