Provider Demographics
NPI:1962738716
Name:LADDEN, JODI LYNN (BCBA)
Entity type:Individual
Prefix:MS
First Name:JODI
Middle Name:LYNN
Last Name:LADDEN
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 1:43227 KATHLEEN ELIZABETH DRIVE
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147
Mailing Address - Country:US
Mailing Address - Phone:703-401-1482
Mailing Address - Fax:703-724-7626
Practice Address - Street 1:43227 KATHLEEN ELIZABETH DRIVE
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147
Practice Address - Country:US
Practice Address - Phone:703-401-1482
Practice Address - Fax:703-724-7626
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CERTIFICANT1-05-2301103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst