Provider Demographics
NPI:1700268380
Name:SHARPE-GONZALEZ, JENNIFER L (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:SHARPE-GONZALEZ
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4275 S AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-5039
Mailing Address - Country:US
Mailing Address - Phone:414-460-1445
Mailing Address - Fax:
Practice Address - Street 1:4275 S AUSTIN ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-5039
Practice Address - Country:US
Practice Address - Phone:414-460-1445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI110-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst