Provider Demographics
NPI:1386489094
Name:BICKEL, JENNIFER ELLEN GOODMAN (BCBA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ELLEN GOODMAN
Last Name:BICKEL
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 1:315 E NORTH DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-6595
Mailing Address - Country:US
Mailing Address - Phone:812-330-7700
Mailing Address - Fax:
Practice Address - Street 1:315 E NORTH DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-6555
Practice Address - Country:US
Practice Address - Phone:812-330-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-14-9581103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst