Individual
JENNA MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
2338 W ROYAL PALM RD, PHOENIX, AZ 85021-9339
(248) 299-0030
Mailing address
2338 W ROYAL PALM RD STE J, PHOENIX, AZ 85021-9339
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-18-29689
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-18-29689
BACB
TX
Enumeration date
05/01/2018
Last updated
04/15/2022
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