Provider Demographics
NPI:1740652510
Name:BALL, JENNA ALAINE (MA, BCBA)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:ALAINE
Last Name:BALL
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22900 BLUE JAY LN
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:CA
Mailing Address - Zip Code:96007-3596
Mailing Address - Country:US
Mailing Address - Phone:530-356-8573
Mailing Address - Fax:530-232-0845
Practice Address - Street 1:1024 MISTLETOE LN STE B
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0753
Practice Address - Country:US
Practice Address - Phone:530-232-0845
Practice Address - Fax:530-232-0845
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-11-9532103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1-11-9532OtherBACB