Jennifer Jill Blackburn, M. ED., BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-19-38078 Issued in NC

Practice address

716 Marsh Rd
Charlotte, NC 28209

Phone

(704) 522-9912

NPI assigned

Aug 13, 2018

Last updated

Sep 24, 2019By the provider in NPPES

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

Credentials

Master of Education

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

{
    "created_epoch": "1534118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569283200000",
    "number": "1366921108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "716 MARSH RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282091851",
            "telephone_number": "704-522-9912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "716 MARSH RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28209",
            "telephone_number": "704-522-9912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "JENNIFER",
        "middle_name": "JILL",
        "credential": "M. ED., BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-13",
        "last_updated": "2019-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NC",
            "license": "1-19-38078",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Reneisha Lachelle Black, LPCA
• Shaphaun Tamara Black, CSAC
• Sheila Ruth Black, LCSW
• Trasha Jacquette Black, PHD, LPC, NCC
• Collin William Blackburn, MD
• Stephanie Anne Blackburn, LCSW
• Donald Wayne Blackley, M.D.
• Aaron T Blackmer, P.A
• Alicia Blackmon
• Ebony Lasha Blackmon

• Behavior Analyst in Charlotte, NC
• Providers in Charlotte, 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 Sep 24, 2019; 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.