Individual
JACLYN RENEE HUMPHREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, BCBA
Contact information
Practice address
1501 W TAPP RD, BLOOMINGTON, IN 47403-3459
(812) 330-4460
(812) 330-4461
Mailing address
6402 W VERNAL PIKE, BLOOMINGTON, IN 47404-9662
(812) 320-9879
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-18-31655
IN
103K00000X
Behavior Analyst
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—
Other
Enumeration date
09/24/2018
Last updated
02/06/2023
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