Individual
JENNA CORNWALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
2070 NORTHBROOK BLVD STE B4, NORTH CHARLESTON, SC 29406-9254
(843) 569-3033
Mailing address
383 ARBUTUS ST, MIDDLETOWN, CT 06457-7102
(860) 301-0226
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
365963
CT
Other
Enumeration date
06/10/2019
Last updated
06/10/2019
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