Individual
JENNIFER LYNN GANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PLBA
Contact information
Practice address
44 PORTWEST CT, SAINT CHARLES, MO 63303-5985
(636) 493-9299
(636) 252-4747
Mailing address
44 PORTWEST CT, SAINT CHARLES, MO 63303-5985
(636) 493-9299
(636) 252-4747
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
2025007352
MO
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
730154901
—
MO
Enumeration date
01/29/2025
Last updated
02/25/2026
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