Jordan Lorraine Penn, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Practice address

905 Friedberg Church Rd
Winston Salem, NC 27127-9803

Phone

(336) 251-1180

NPI assigned

Dec 21, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Abc of NC Child Development Center

  • Early Intervention Provider Agency
  • Winston Salem, NC
  • NPI 1922277417

  Behavior Analyst

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1640044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640044800000",
    "number": "1023778727",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 FOREST PARK CIR APT 228",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271275076",
            "telephone_number": "336-710-9831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 FRIEDBERG CHURCH RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271279803",
            "telephone_number": "336-251-1180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENN",
        "first_name": "JORDAN",
        "middle_name": "LORRAINE",
        "name_prefix": "Ms.",
        "credential": "BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-21",
        "last_updated": "2021-12-21",
        "certification_date": "2021-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carol L Penick, LPC
• Suresh Jagannath Penkar, M.D.
• Heather L Penland, CRNA
• Christopher James Penley
• Heather Penley
• Joycelyn N Penn
• Kimberly Penn
• Kaiarose Penner
• Megan C Pennington
• Shannan Pennington, FNP-BC

• Behavior Analyst in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Behavior Analyst in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.