Provider Demographics
NPI:1427607670
Name:LUNDQUIST, JENNA (RBT)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:LUNDQUIST
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 E PECOS RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-6077
Mailing Address - Country:US
Mailing Address - Phone:480-846-0607
Mailing Address - Fax:480-841-6696
Practice Address - Street 1:2141 E PECOS RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-6077
Practice Address - Country:US
Practice Address - Phone:480-846-0607
Practice Address - Fax:480-841-6696
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-18-56494106S00000X
AZBEH-000584103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ080591Medicaid