Provider Demographics
NPI:1124254057
Name:PAN, JENNY LYNN GALAMAGA (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:LYNN GALAMAGA
Last Name:PAN
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:LYNN
Other - Last Name:GALAMAGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:53869 CONNOR DR.
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051
Mailing Address - Country:US
Mailing Address - Phone:773-241-4009
Mailing Address - Fax:
Practice Address - Street 1:53869 CONNOR DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-3930
Practice Address - Country:US
Practice Address - Phone:586-209-3683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003661103K00000X
103K00000X
MI7401000363103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst