Individual
MRS. JENNA M MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
1639 E 800 N, WEST LAFAYETTE, IN 47906-9007
(765) 427-6280
Mailing address
1639 E 800 N, WEST LAFAYETTE, IN 47906
(765) 427-6280
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-14-1464
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-14-16464
BCBA
IN
Enumeration date
09/16/2015
Last updated
09/16/2015
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