Individual
JEANNIE LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
1161 N EL DORADO PL # 103, TUCSON, AZ 85715-4607
(520) 748-7108
Mailing address
5958 E 33RD ST, TUCSON, AZ 85711-6835
(520) 909-3865
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
158008
—
AZ
Enumeration date
03/09/2015
Last updated
10/04/2016
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