Provider Demographics
NPI:1356873269
Name:HILGOE, JENNA (BCBA)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:HILGOE
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 1:108 W FIRE TOWER RD STE G
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28590-8408
Mailing Address - Country:US
Mailing Address - Phone:252-751-0518
Mailing Address - Fax:252-565-4505
Practice Address - Street 1:108 W FIRE TOWER RD STE G
Practice Address - Street 2:
Practice Address - City:WINTERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28590-8408
Practice Address - Country:US
Practice Address - Phone:252-751-0518
Practice Address - Fax:252-565-4505
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1-17-25480103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst