Jenny Vickhammer, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-18-31807 Issued in NU

Practice address

12553 W Explorer Dr
Boise, ID 83713-1601

Phone

(406) 549-6413

NPI assigned

Dec 19, 2018

Last updated

Jun 30, 2020By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1545177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593475200000",
    "number": "1265904072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1073 OVERLAND TRAIL ST",
            "city": "MIDDLETON",
            "state": "ID",
            "postal_code": "836445879",
            "telephone_number": "406-250-3056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12553 W EXPLORER DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837131601",
            "telephone_number": "406-549-6413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICKHAMMER",
        "first_name": "JENNY",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-19",
        "last_updated": "2020-06-30",
        "certification_date": "2020-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": "1-18-31807",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Veterans Adminisatration Medical Center
• Veterans Pharma Incorporated (Premium Rx Services)
• Gretchen Vetter, PA
• Vibra Hospital of Boise LLC (Vibra Hospital of Boise)
• Amber M Vickers, PA-C
• Cymbria Arielynn Victor
• Devon Victorine
• Victory Medical Transportation
• Victory Medical Transportation, Inc. (Victory EMS)
• Victory Surgical Services PLLC

• Behavior Analyst in Boise, ID
• Providers in Boise, ID by specialty
• Behavior Analyst in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2020; 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.