Provider Demographics
NPI:1194388025
Name:KOGER, JENNIFER (MS, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KOGER
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2489 E OLIVINE RD
Mailing Address - Street 2:
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85143-4903
Mailing Address - Country:US
Mailing Address - Phone:562-955-9928
Mailing Address - Fax:
Practice Address - Street 1:2489 E OLIVINE RD
Practice Address - Street 2:
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85143-4903
Practice Address - Country:US
Practice Address - Phone:562-955-9928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBEH-000765103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-20-44645OtherBCBA CERTIFICATE