Provider Demographics
NPI:1982985859
Name:EDGINGTON, JENNIFER LYNN (MS BCBA, LBA, IBA)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNN
Last Name:EDGINGTON
Suffix:
Gender:F
Credentials:MS BCBA, LBA, IBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 VALLEY VIEW DR APT 7
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-6224
Mailing Address - Country:US
Mailing Address - Phone:319-270-2854
Mailing Address - Fax:
Practice Address - Street 1:736 VALLEY VIEW DR APT 7
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-6224
Practice Address - Country:US
Practice Address - Phone:319-270-2854
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-11-8921103TR0400X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL123456OtherMOST MAJOR INSURANCE COMPANIES
IL1982985859OtherNPI