Provider Demographics
NPI:1124735667
Name:KUBE, JENNIFER LEI (BCBA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEI
Last Name:KUBE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 TRAVIS RD
Mailing Address - Street 2:
Mailing Address - City:ROSSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30741-4925
Mailing Address - Country:US
Mailing Address - Phone:262-385-1316
Mailing Address - Fax:
Practice Address - Street 1:4406 BRAINERD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-5426
Practice Address - Country:US
Practice Address - Phone:423-899-4747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst