Provider Demographics
NPI:1801507843
Name:ST. JOHN, JENNIFER JEAN (MA, BCBA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JEAN
Last Name:ST. JOHN
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 1:1183 S WILD PHLOX WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1770
Mailing Address - Country:US
Mailing Address - Phone:208-891-9189
Mailing Address - Fax:
Practice Address - Street 1:1183 S WILD PHLOX WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-1770
Practice Address - Country:US
Practice Address - Phone:208-891-9189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst