Jennifer Lynn Willis

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

1520 N Mountain Ave Ste 206
Ontario, CA 91762-1133

Phone

(909) 689-4135

NPI assigned

Jan 26, 2021

Last updated

Jan 26, 2021By 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

Electronic endpoints 1

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": "1611619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611619200000",
    "number": "1548850225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 S PALM WAY APT 6",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928021950",
            "telephone_number": "562-546-9021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 N MOUNTAIN AVE STE 206",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917621133",
            "telephone_number": "909-689-4135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-26",
        "last_updated": "2021-01-26",
        "certification_date": "2021-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Jennifer.l.willis@biola.edu",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1520 N Mountain Ave Ste 206",
            "city": "Ontario",
            "state": "CA",
            "country_code": "US",
            "postal_code": "917621133",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Patricia Joanne Williams, MSW
• Shanael Williams
• Tyler Williams
• Aundrea Mariah Williamson
• Kayla Willis Bunn
• Jessica Willis
• Willow and Cypress Consulting
• Emerson J Wills
• Derrisha Charnee Wilson Graham
• Varda Wilson Thompson

• Behavior Technician in Ontario, CA
• Providers in Ontario, CA by specialty
• Behavior Technician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 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.