Jennifer Lynn Gentrup

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

43490 Yukon Dr Ste 104
Ashburn, VA 20147-7302

Phone

(703) 936-2122

NPI assigned

Jul 22, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jennifer Lynn Graham Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

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.

• Center for Autism and Related Disorders

  • Behavior Technician
  • Ashburn, VA
  • NPI 1124737564
  NPD

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

{
    "created_epoch": "1658448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658448000000",
    "number": "1063147015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25326 DILIGENCE CT",
            "city": "ALDIE",
            "state": "VA",
            "postal_code": "201053407",
            "telephone_number": "703-965-4302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "43490 YUKON DR STE 104",
            "city": "ASHBURN",
            "state": "VA",
            "postal_code": "201477302",
            "telephone_number": "703-936-2122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GENTRUP",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-22",
        "last_updated": "2022-07-22",
        "certification_date": "2022-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.centerforautism.com",
            "affiliation": "N",
            "address_1": "43490 Yukon Dr Ste 104",
            "city": "Ashburn",
            "state": "VA",
            "country_code": "US",
            "postal_code": "201477302",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "GRAHAM",
            "middle_name": "LYNN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Katie Lynne Garland
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• Nick Gentile, LPC
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• Giant of Maryland LLC
• Giant of Maryland LLC
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• Behavior Technician in Ashburn, VA
• Providers in Ashburn, VA by specialty
• Behavior Technician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2022; 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.