Provider Demographics
NPI:1407530298
Name:DANNER, JENNIFER LYNN (BCBA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:DANNER
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2142 TODD RAILROAD GRADE RD APT B
Mailing Address - Street 2:
Mailing Address - City:TODD
Mailing Address - State:NC
Mailing Address - Zip Code:28684-9619
Mailing Address - Country:US
Mailing Address - Phone:336-940-7562
Mailing Address - Fax:
Practice Address - Street 1:2142 TODD RAILROAD GRADE RD APT B
Practice Address - Street 2:
Practice Address - City:TODD
Practice Address - State:NC
Practice Address - Zip Code:28684-9619
Practice Address - Country:US
Practice Address - Phone:336-940-7562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-25-80880103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst