Individual
JENA SUZANNE NICKERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA LBA-TX
Contact information
Practice address
1100 CIRCLE DR STE 101, FORT WORTH, TX 76119-8111
(817) 566-1100
Mailing address
1100 CIRCLE DR STE 101, FORT WORTH, TX 76119-8111
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
5504
TX
Other
Enumeration date
01/04/2023
Last updated
01/04/2023
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