Individual
JENNIFER SUE DODGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BACB499833
Contact information
Practice address
42 LOST RIVER RD, MAZAMA, WA 98833-9707
(404) 247-4514
Mailing address
PO BOX 154, BREWSTER, WA 98812-0154
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
BACB499833
WA
106S00000X
Behavior Technician
Primary
RBT-21-178990
WA
Other
Enumeration date
06/28/2021
Last updated
08/23/2021
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