Provider Demographics
NPI:1669795829
Name:DEIEN, JENNIFER L (MS, BCBA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:DEIEN
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:BECHTOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:550 N REO ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-1061
Mailing Address - Country:US
Mailing Address - Phone:813-374-2070
Mailing Address - Fax:
Practice Address - Street 1:1413 TECH BLVD STE 122
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-7822
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-02
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
1-09-5653103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst