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Individual

TIA JAENICKE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
BCBA

Contact information

Practice address
6855 SHORE TER STE 130, INDIANAPOLIS, IN 46254-4663
(855) 772-8847
Mailing address
27777 INKSTER RD STE 100, FARMINGTON HILLS, MI 48334-5312
(888) 772-8847

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-19-37151
103K00000X
Behavior Analyst

Other

Enumeration date
12/03/2019
Last updated
08/30/2025
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