Provider Demographics
NPI:1770152548
Name:HOLDER, JENNIFER (MS, BCBA, LBS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HOLDER
Suffix:
Gender:F
Credentials:MS, BCBA, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11034 CERVONE DR
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-4716
Mailing Address - Country:US
Mailing Address - Phone:814-882-2078
Mailing Address - Fax:
Practice Address - Street 1:18282 TEACHNOLOGY DR
Practice Address - Street 2:SUITE #204
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335
Practice Address - Country:US
Practice Address - Phone:814-336-2848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-20-43781103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst