Provider Demographics
NPI:1457632986
Name:NUERNBERGER, JODI E (MS, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:E
Last Name:NUERNBERGER
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500C S LEWIS LN
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-3448
Mailing Address - Country:US
Mailing Address - Phone:715-225-3967
Mailing Address - Fax:
Practice Address - Street 1:500C S LEWIS LN
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-3448
Practice Address - Country:US
Practice Address - Phone:715-225-3967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst