Provider Demographics
NPI:1467937359
Name:MILLER, JENNIFER LYNN (BCBA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:MILLER
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 1:509 NW 116TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73114-7910
Mailing Address - Country:US
Mailing Address - Phone:405-519-6797
Mailing Address - Fax:
Practice Address - Street 1:1960 HARPER ST
Practice Address - Street 2:
Practice Address - City:CHOCTAW
Practice Address - State:OK
Practice Address - Zip Code:73020-8095
Practice Address - Country:US
Practice Address - Phone:405-281-1040
Practice Address - Fax:405-987-1070
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS079103K00000X
OK1-16-22214103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst