Jenna Young
Individual provider Active NPI Behavior Analyst · Tilton, IL
NPI 1053897504 · NPPES record last updated Jul 18, 2018
Key facts
- NPI
- 1053897504
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Analyst 103K00000X
- Practice address
- 1630 Georgetown Rd Ste 3
Tilton, IL 61833-8110 - Phone
- (708) 305-7106
- NPI assigned
- Jul 18, 2018
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | Yes |
Addresses
Primary practice location
1630 Georgetown Rd Ste 3
Tilton, IL 61833-8110
Mailing address
25137 Faraday Rd
Manhattan, IL 60442-6215
Other providers in Tilton, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.